Abstract Details

Title Sarcopenia Measured by Temporalis Muscle Thickness Independently Predicts Early Relapse and Short Survival in Primary CNS Lymphoma

Topic Neuro-oncology

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-002

Background

PCNSL outcomes diverge between a majority of patients who achieve long term remission and a minority who have an aggressive disease course and die in the first year. Sarcopenia, loss of muscle mass and function over time, has been recognized as a powerful predictor of mortality in brain and systemic cancers. TMT is a validated radiographic measure of sarcopenia. We hypothesized that patients with TMT less than one standard deviation below the mean (“very thin TMT”) have a higher chance of relapse and early mortality.

Objective

Utilize temporalis muscle thickness (TMT) as a measure of sarcopenia on pretreatment MRI to predict survival and risk of relapse in patients with primary CNS lymphoma (PCNSL).

Design/Methods Two blinded operators retrospectively measured TMT in 99 consecutive pretreatment brain MRIs from patients subsequently diagnosed with PCNSL. Overall survival and progression-free survival were calculated for patients stratified by TMT.

Results

On univariate analysis, TMT predicted early progression (HR 4.25, 95% CI 1.95 – 9.29, p<0.001) and early mortality (HR 4.38, 95% CI 2.25 – 8.53, p<0.001). These effects were maintained in subgroups of patients both <65 and ≥ 65 years of age. Very thin TMT predicted mortality more robustly than IELSG or MSKCC scores. Patients with very thin TMT received fewer cycles of high-dose methotrexate (HD-MTX) and were less likely to receive consolidation. On multivariate analysis which included age, sex, TMT, ECOG, BMI, lifetime doses of HD-MTX, and consolidation, very thin TMT was independently associated with both early progression (HR = 7.87, 95% CI = 3.55 – 17.45, p<0.001) and short survival (HR 4.49, 95% CI = 1.94 – 10.40, p<0.001).

Conclusions

We conclude that PCNSL patients with very thin TMT are at high risk for relapse and short survival. Further, TMT provides additional data in stratifying patients at the time of diagnosis for individualized treatment regimens.

Authors/Disclosures
Anthony M. Menghini PRESENTER	Mr. Menghini has nothing to disclose.
Alipi Bonm (Swedish Medical Center)	Dr. Bonm has nothing to disclose.
Jerome J. Graber, MD, MPH, FAAN (University of Washington)	Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for American Academy of Neurology. Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Dickie McCamey Attorneys at Law. Dr. Graber has a non-compensated relationship as a Editorial Board member with Neuro-Oncology: Practice, published by Oxford that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Journal of Pain and Symptom Management that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors and Certification Exam Committee Member with United Council of Neurogical Subspecialties that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Question of the Day 'app' committee and NeuroSAE and Continuum with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Practical Neurology (BMC) that is relevant to AAN interests or activities.