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Muscle mass change during chemotherapy in children with high-risk neuroblastoma: a retrospective case series of 24 patients

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Abstract

The clinical characteristics, cause, and risk factors of sarcopenia are unclear in children. The aim of this study was to describe the course of and identify the factors related to muscle mass change during chemotherapy in children with neuroblastoma. A total of 24 consecutive patients aged below 18 years with newly diagnosed high-risk neuroblastoma between 2010 and 2018 in our hospital were enrolled in a case-series study. The psoas muscle index (PMI) was calculated as a parameter of muscle mass based on computer tomography (CT) images of the psoas muscle. PMIs were evaluated at 4 time points (TPs): TP1, at the diagnosis of neuroblastoma; TP2, after the first cycle of chemotherapy; TP3, after the third cycle of chemotherapy; and TP4, at the end of the induction chemotherapy. PMI recovery was defined as an increase in PMI between TP2 and TP4. The mean PMI decreased by 15% between TP1 and TP2 (TP1 7.09 ± 0.99 vs. TP2 6.01 ± 0.98, P < 0.001) and by 10% between TP1 and TP4 (TP1 7.09 vs. TP4 6.35, P = 0.004). PMI recovery between TP1 and TP2 was observed in 7 (29%) patients. The median age of patients with PMI recovery was significantly lower (2 vs. 4 years, P = 0.028), and the proportion of boys was significantly higher in patients with PMI recovery (100% vs. 41%, P = 0.017).

Conclusion: This study demonstrated that prominent PMI reduction occurs during the early time of chemotherapy, and a younger age and male sex may be predictive factors for PMI recovery.

What is Known:

• Sarcopenia is a common disorder in elderly people.

• Several causes and risk factors have been reported in adults.

• Children with previous hematological malignancies have decreased physical activity.

What is New:

• Prominent muscle mass loss was observed early in children with high-risk neuroblastoma during chemotherapy.

• Age and sex were found to be potentially associated with muscle mass recovery.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

N/A.

Abbreviations

ALL:

Acute lymphoblastic leukemia

BMI:

Body mass index

BSA:

Body surface area

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group

INPC:

International Neuroblastoma Pathology Classification

INSS:

International Neuroblastoma Staging System

MKI:

Mitosis-karyorrhexis index

PS:

Performance status

PMCSA:

Psoas muscle cross-sectional area

QOL:

Quality of life

TP:

Time point

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Author information

Authors and Affiliations

  1. Pediatric Emergency Department, Hyogo Prefectural Amagasaki General Medical Center, Higashi-Naniwacho 2-17-77, Amagasaki, 660-8550, Japan

    Natsumi Nakamura

  2. Department of Hematology & Oncology, Children’s Cancer Center, Kobe Children’s Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047, Japan

    Kenji Kishimoto, Toshiaki Ishida, Sayaka Nakamura, Akihiro Tamura, Aiko Kozaki, Atsuro Saito, Daiichiro Hasegawa & Yoshiyuki Kosaka

Authors
  1. Natsumi Nakamura
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  2. Kenji Kishimoto
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  3. Toshiaki Ishida
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Contributions

NN conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. KK conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and critically reviewed the manuscript for important intellectual content. TI, SN, AT, AK, and AS collected data, and reviewed and revised the manuscript. DH and YK conceptualized and designed the study, coordinated and supervised data collection, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Kenji Kishimoto.

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Ethics approval

This study was approved by the Institutional Review Board of Kobe Children’s Hospital (approval number: R30-18).

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Conflict of interest

The authors declare no competing interests.

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Communicated by Daniele De Luca

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Nakamura, N., Kishimoto, K., Ishida, T. et al. Muscle mass change during chemotherapy in children with high-risk neuroblastoma: a retrospective case series of 24 patients. Eur J Pediatr 180, 3265–3271 (2021). https://doi.org/10.1007/s00431-021-04106-y

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  • DOI: https://doi.org/10.1007/s00431-021-04106-y

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