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Prognostic Impact of Quantifying Sarcopenia and Adipopenia by Chest CT in Severe Aplastic Anemia Patients Treated With Allogeneic Hematopoietic Stem Cell Transplantation

  • Author Footnotes
    # Dandan Chen, Zhaohu Yuan and Yuan Guo contributed equally to this work.
    Dandan Chen
    Footnotes
    # Dandan Chen, Zhaohu Yuan and Yuan Guo contributed equally to this work.
    Affiliations
    Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China

    First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China
    Search for articles by this author
  • Author Footnotes
    # Dandan Chen, Zhaohu Yuan and Yuan Guo contributed equally to this work.
    Zhaohu Yuan
    Footnotes
    # Dandan Chen, Zhaohu Yuan and Yuan Guo contributed equally to this work.
    Affiliations
    Department of Blood Transfusion, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
    Search for articles by this author
  • Author Footnotes
    # Dandan Chen, Zhaohu Yuan and Yuan Guo contributed equally to this work.
    Yuan Guo
    Footnotes
    # Dandan Chen, Zhaohu Yuan and Yuan Guo contributed equally to this work.
    Affiliations
    Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
    Search for articles by this author
  • Wenjian Mo
    Affiliations
    Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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  • Weifeng Liu
    Affiliations
    Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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  • Dan Liang
    Affiliations
    Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
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  • Amei Chen
    Affiliations
    Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
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  • Yan Zhang
    Affiliations
    Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
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  • Nianru Zhang
    Affiliations
    Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
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  • Xinhua Wei
    Correspondence
    Address correspondence to: Xinhua Wei, 1 Panfu Road, Yuexiu District, Guangzhou, Guangdong 510180, PR China. Tel.: +86 020-81048873; Fax: +86 020-81048873.
    Affiliations
    Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China

    First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China
    Search for articles by this author
  • Author Footnotes
    # Dandan Chen, Zhaohu Yuan and Yuan Guo contributed equally to this work.
Published:November 12, 2022DOI:https://doi.org/10.1016/j.acra.2022.10.017

      Rationale and Objectives

      To investigate the prognostic role of chest CT-defined sarcopenia and adipopenia in severe aplastic anemia (SAA) patients treated with hematopoietic stem cell transplantation (HSCT).

      Materials and Methods

      This was a retrospective study of 123 consecutive SAA patients treated with HSCT. CT imaging was performed to quantify the pectoralis muscle (including major and minor) index (PMI) and the corresponding subcutaneous adipose tissue index (SAI). Sarcopenia and adipopenia were defined as PMI and SAI lower than the respective sex-specific medians. Correlations of the PMI and SAI with anthropometric indexes were calculated. Transplant-related outcomes were compared between the sarcopenia and adipopenia groups. Prognostic factors for overall survival (OS) and fail-free survival (FFS) were identified by Cox regression and were used to create a nomogram. The accuracy of the nomogram was evaluated by ROC curves.

      Results

      PMI showed good correlation with BMI and fat-free mass index (p < 0.001). SAI correlated with BMI and fat mass index (p < 0.001). The sarcopenia group (47.2%) had a significantly worse 3-year OS (90.8% vs. 77.6%, p = 0.045) and 3-year FFS (89.2% vs. 74.1%, p = 0.035) than the nonsarcopenia group. Sarcopenia status and diagnostic category were used to construct the nomogram of OS, as these were independent prognostic factors in the multivariate analysis for OS and FFS (p < 0.05). The area under the curve of the nomogram at one year and three years was 0.801 and 0.721, respectively.

      Conclusion

      Sarcopenia indicates a poor prognosis in SAA patients undergoing HSCT. Intensive supportive care is suggested for SAA patients with sarcopenia before transplantation.

      Key Words

      Abbreviations:

      SAA (severe aplastic anemia), HSCT (hematopoietic stem cell transplantation), PMI (pectoralis muscle index), SAI (subcutaneous adipose tissue index), OS (overall survival), FFS (fail free survival), FFMI (fat-free mass index), FMI (fat mass index), MSD (matched sibling donor), MUD (matched unrelated donor), HID (haploidentical donor)
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