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Sarcopenia among patients after allogeneic hematopoietic stem cell transplantation and the impact of chronic graft-versus-host disease

Journal of Cancer Research and Clinical Oncology volume 146, pages 2967–2978 (2020)Cite this article

Abstract

Purpose

This study investigated the frequency and characteristics of sarcopenia among patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) with a specific focus on the chronic graft-versus-host disease (cGVHD) population and its association with malnutrition, vitamin D and clinical characteristics.

Methods

We assessed sarcopenia, vitamin D levels, and nutritional status in 73 patients who underwent allo-HSCT, of which 45 were diagnosed with cGVHD. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria.

Results

Sarcopenia was diagnosed in 19.2% of patients after allo-HSCT with statistically no significant difference between cGVHD and non-cGVHD patients. The risk factor for sarcopenia was the male gender. Sarcopenia in allo-HSCT patients correlated strongly with malnutrition and with current corticosteroid treatment (p < 0.005). Among cGVHD patients sarcopenia additionally correlated strongly with the number of prior systemic immunosuppressive therapy lines (p < 0.005) and moderately with the intensity of immunosuppression, cGVHD severity global rating assessed by both the health care provider and the patient and joint and fascia cGVHD involvement (p < 0.05). Vitamin D deficiency was found in more than 54.8% of patients, but the correlation to sarcopenia was not found.

Conclusion

Sarcopenia was found to be common in long term survivors of allo-HSCT independently of the cGVHD diagnosis. Prospective longitudinal studies are needed for a better understanding of factors affecting the development of sarcopenia after allo-HSCT.

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Acknowledgements

This work was supported, in part, by the Unity Through Knowledge Fund project entitled “Clinical and biological factors determining severity and activity of chronic Graft-versus-Host disease after allogeneic hematopoietic stem cell transplantation”, and also, in part, by the Croatian Science Foundation project IP-2016-06-8046 entitled “New biomarkers for chronic graft-versus-host disease”. We would also like to thank the many members of the multidisciplinary team for cGVHD at the University Hospital Center Zagreb, Croatia.

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Authors and Affiliations

  1. Clinical Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Dina Ljubas Kelecic, Irena Karas, Darija Vranesic Bender & Zeljko Krznaric

  2. School of Medicine, University of Zagreb, Zagreb, Croatia

    Antonela Lelas, Zinaida Peric, Nadira Durakovic, Radovan Vrhovac, Damir Nemet, Drazen Pulanic & Zeljko Krznaric

  3. Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Lana Desnica, Ranka Serventi Seiwerth, Zinaida Peric, Nadira Durakovic, Radovan Vrhovac, Damir Nemet & Drazen Pulanic

  4. Department of Rehabilitation and Orthopedic Aids, University Hospital Centre Zagreb, Zagreb, Croatia

    Tamara Vukic

  5. Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia

    Ivan Sabol

  6. Department of Food Chemistry, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia

    Dubravka Vitali Cepo

  7. Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, USA

    Steven Pavletic

  8. Division of Gastroenterology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Zeljko Krznaric

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  1. Dina Ljubas Kelecic
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  2. Antonela Lelas
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  3. Irena Karas
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  9. Zinaida Peric
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Correspondence to Dina Ljubas Kelecic.

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Ljubas Kelecic, D., Lelas, A., Karas, I. et al. Sarcopenia among patients after allogeneic hematopoietic stem cell transplantation and the impact of chronic graft-versus-host disease. J Cancer Res Clin Oncol 146, 2967–2978 (2020). https://doi.org/10.1007/s00432-020-03280-0

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Keywords

  • Sarcopenia
  • Allo-HSCT
  • cGVHD
  • Malnutrition
  • Hand-grip strength
  • Vitamin D