The geriatric syndrome of sarcopenia impacts allogeneic hematopoietic cell transplantation outcomes in older lymphoma patients

Abstract

Older patients with advanced hematologic malignancies are increasingly considered for allogeneic hematopoietic cell transplantation (allo-HCT) yet their survival outcomes remain suboptimal. We and others have previously shown that pre-HCT multi-morbidity and functional limitation and post-HCT geriatric syndromes significantly impact outcomes. Sarcopenia, an accelerated loss of muscle mass and function, has been increasingly recognized in older cancer patients. We identified 146 lymphoma patients 50 years or older who were allografted from 2008 to 2018 at our institution and found that before allo-HCT, 80 (55%) patients were sarcopenic. Pre-HCT sarcopenia was significantly associated with overall survival, progression-free survival, and nonrelapse mortality independent of multi-morbidity and functional limitation. In 6-month landmark analysis, post-HCT sarcopenia remained significantly associated with survival. Our findings illustrate the high prevalence and profound impact of sarcopenia on survival. While requiring prospective confirmation, preemptive, longitudinal, and multidisciplinary interventions for sarcopenia are warranted to improve HCT outcomes for older patients.

Keywords:

• Sarcopenia
• geriatric assessment
• lymphoma
• allogeneic hematopoietic cell transplantation

Acknowledgments

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. RJL acknowledges support from the Elsa U. Pardee Foundation for Cancer Research, New York State Empire Clinical Research Investigator Program, Parker Institute for Cancer Immunotherapy at MSK, and the Dresner MDS Foundation. This work is presented in part at the 61^st American Society of Hematology Annual Meeting and Exposition, December 6–9, 2019, Orlando, FL.

Disclosure statement

SAG – Advisory Board for Amgen, Actinuum, Celgene, Johnson & Johnson, Jazz pharmaceutical, Takeda, Novartis, Kite, Spectrum Pharma; Research funding from Amgen, Actinuum, Celgene, Johnson & Johnson, Miltenyi, Takeda.

GLS – Research funding from Janssen and Amgen.

MS – Consultancy and research funding: Angiocrine Bioscience, Inc.; Consultancy: McKinsey & Company; Consultancy on Advisory Boards for: Omeros Corporation and Kite Pharma.

PAH – Research support and consulting fees from Portola Pharmaceuticals, Inc. Consultancy on advisory boards for: Astra-Zeneca, Celgene, Karyopharm.

CSS – Consultant on advisory boards for: Juno Therapeutics, Sanofi Genzyme, Spectrum Pharmaceuticals, Novartis, Precision Biosciences, Kite, a Gilead Company and GSK. Research funds for investigator-initiated trials from: Juno Therapeutics and Sanofi-Genzyme.

MAP – Honoraria from Abbvie, Bellicum, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, and Takeda. He serves on DSMBs for Servier and Medigene, and the scientific advisory boards of MolMed and NexImmune. Research support for clinical trials from Incyte, Kite (Gilead) and Miltenyi Biotec.

IP – has received research support from Merck and serves on a Data and Safety Monitoring Board (DSMB) for ExCellThera.

Additional information

Funding

This research was supported in part by NIH/NCI Program Project Grant P01 CA023766 and Cancer Center Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center.