| Background and objective: The tolerance of patients with DLBCL receiving CHOP±R regimen was significantly different,and grade 3~4 hematologic toxicity after chemotherapy in some patients resulted in prolonged hospital stay,increased risk of infection,delayed treatment,and directly or indirectly affected short-term efficacy and long-term prognosis.LBM and L3 SMI obtained from abdominal CT of DLBCL patients were analyzed to determine whether they could be used as independent predictors of hematological toxicity of CHOP± R regimen in DLBCL patients.Research methods: The patients with DLBCL who underwent CHOP±R regimen at the Cancer Center of the First Hospital of Jilin University from January 2015 to November 2018 were retrospectively analyzed.The abdominal CT of the patient was analyzed by sliceOmatic5.0 software.The third lumbar disc planar imaging was selected,and two consecutive images were takento calculate LBM and L3 SMI.Single factor and multivariate analysis were performed on the correlation of LBM,L3 SMIand chemotherapy-related grade 3~4 hematologic toxicity.The ROC curve was drawn to investigate the predictive value of various human indicators on the hematologic toxicity of grade 3~4 related to chemotherapy.Results: 1.Normal information: A total of 60 patients with diffuse large B-cell lymphoma were included.There were 27 males and 33 females with an average age of(55.83±13.33)years old.2.Univariate analysis results:(1)Anthropometric indicators: The BMI of the included patients was(23.21±3.78)kg/m~2,and the BMI of the <3 grade neutrophil count decrease group and the ? 3 grade neutrophil count decrease group were(23.57±4.02)kg/m~2 and(22.73±3.45)kg/m~2,the results were not statistically different.The BMI of patients in the grade <3 leukopenia group and the grade ?3 leukopenia group were(24.27±4.26)kg/m~2 and(21.73±2.33)kg/m~2.The results were statistically significant(P<0.05).The BSA was(1.77±0.36)m~2,and the BSA of the <3 grade neutrophil count decrease group and the ?3 grade neutrophil count decrease group were(1.78±0.36)m~2 and(1.75±0.37)m~2,respectively difference.The BSA of the <3 grade leukopenia group and the grade ? 3 leukopenia group were(1.81±0.33)m~2 and(1.71±0.40)m~2.The results were not statistically different.(2)Laboratory test indicators: Alb is(38.37±5.55)g/L.<3 grade neutrophil count reduction was(38.58±5.64)g/L,and ?3 grade neutrophil count decrease was(38.09±5.52)g/L.There was no significant difference between the two groups.<3 grade leukopenia group was(39.43±5.63)g/L,and ?3 grade leukopenia group was(36.93±5.20)g/L.There was no significant difference in Alb between the two groups.(3)Body composition index: L3 SMI,LBM were(42.34±8.79)cm~2/m~2,(40.54±8.66)kg.<3 grades of neutrophil count decrease group and ?3 grade neutrophil count decrease group L3 SMI were(44.79±9.11)cm~2/m~2 and(39.13±7.36)cm~2/m~2,respectively difference.The L3 SMI of patients with ?3 grade neutrophil count reduction was significantly lower than that of patients with <3 grade neutrophil count reduction,the difference was statistically significant(P<0.05).The L3 SMI of the patients in the grade <3 leukopenia group and the grade ?3 leukopenia group were(45.60±9.23)cm~2/m~2 and(37.76±5.67)cm~2/m~2 and the L3 SMI of patients with ?3 grade leukopenia was significantly lower than that of the grade <3 leukocytes.Patients in the reduced group had significant statistical differences(P< 0.001).The LBM of the grade <3 neutrophil count reduction group and the ?3 grade neutrophil count reduction group were(42.17±8.84)kg and(38.41±8.10)kg,which were not statistically significant.The LBM of the <3 grade leukopenia group and the grade 3leukopenia group were(43.31±9.18)kg and(36.67±6.19)kg,respectively,with statistical difference(P<0.05).3.Multivariate analysis results: Multivariate logistic regression analysis was performed on factors affecting the reduction of neutrophil counts in grades 3~4.Including factors including L3 SMI,BMI,Alb,creatinine,urea nitrogen,AST,ALT,cholinesterase,results shows that the difference in L3 SMI is statistically significant and is an independent predictor of the reduction in neutrophil count in patients with diffuse large B-cell lymphoma treated with the CHOP±R regimen.The risk of neutrophil reduction in patients with low L3 SMI was significantly higher than that in the control group(OR: 0.893,95%CI [0.818-0.975],P=0.012).Multivariate logistic regression analysis was performed on the factors affecting the occurrence of grade 3~4 leukopenia.The inclusion factors included L3 SMI,BMI,Alb,creatinine,urea nitrogen,AST,ALT,and cholinesterase.The results showed: differences in L3 SMI statistically significant,it is an independent predictor of leukopenia in patients with diffuse large B-cell lymphoma treated with the CHOP±R regimen.The risk of chemotherapy-related grade 3~4 leukopenia was significantly higher in patients with low L3 SMI than in the control group(OR: 0.871,95% CI [0.785-0.968],P=0.009).4.Diagnostic value of different body composition indicators for grade 3~4 hematological toxicity: ROC curve analysis showed that thearea under the L3 SMI curve for the reduction of neutrophil count in patients with diffuse large B-cell lymphoma treated with CHOP ± R regimen was 0.681,P = 0.018.The absolute value of ?3 neutrophils decreased and the L3 SMI threshold of <3 neutrophil count reduction was 39.91 cm~2/m~2,with a sensitivity of 0.65 and a specificity of 0.70.ROC curve analysis showed that the area under the L3 SMI curve of leukopenia in patients with diffuse large B-cell lymphoma treated with CHOP±R regimen was 0.74,P=0.002;the area under the LBM curve was 0.705,P=0.007.The critical values of L3 SMI,LBMin the ?3 leukopenia group and the <3 grade leukopenia group were 39.91 cm~2/m~2,40.50 kg,respectively.The sensitivity of L3 SMI was 0.68 and the specificity was 0.71;the sensitivity of LBM was 0.80,the specificity was 0.56.Conclusion: 1.The L3 skeletal muscle index is associated with the occurrence of grade 3~4 hematologic toxicity(leukocyte and neutropenia)in patients with diffuse large B-cell lymphoma treated with CHOP±R regimen.Those with lower L3 SMI are prone to grade 3~4 hematologic toxicity.2.LBM is associated with the occurrence of grade 3~4 hematologic toxicity(leukopenia)in patients with diffuse large B-cell lymphoma treated with CHOP±R regimen.This with lower LBM is prone to grade 3~4 hematologic toxicity.3.The L3 skeletal muscle index can be used as an independent predictor of grade 3~4 hematologic toxicity(leukocyte and neutropenia)in patients with diffuse large B-cell lymphoma treated with CHOP ± R regimen.The cut-off value can be defined as 39.91 cm~2/m~2. |
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