Sarcopenia Screening Allows Identifying High-Risk Patients for Allogenic Stem Cell Transplantation

SIMPLE SUMMARY: Allogenic stem cell transplantation is a treatment option for various hematological diseases. Due to the intensity of the therapy regimes used, there is a substantial therapy associated mortality and morbidity. Therefore, it is crucial to identify patients with increased risk for treatment associated complications. Sarcopenia, defined as the loss of muscle mass and strength is a risk factor in various diseases. Aim of our study was to implement and evaluate the predictive power of a sarcopenia assessment, based on muscle mass, muscle strength and aerobic capacity (by measuring peak oxygen uptake), on all-cause and non-relapse mortality. A total of 178 patients were screened, with 28% suffering from sarcopenia before transplantation. Our results show a three-fold increase in all-cause and non-relapse mortality in this subpopulation compared to non-sarcopenic patients within a 12-month follow up. The importance of physical performance status demonstrated, raises the question, if exercise interventions might even allow to decrease mortality and morbidity. ABSTRACT: Allogenic stem cell transplantation (aSCT) is the only potentially curative treatment for high-risk hematological diseases. Despite advancements in supportive measures, aSCT outcome is still affected by considerable transplant-related mortality. We implemented a new sarcopenia assessment prior to aSCT to evaluate its predictive capability for all-cause and non-relapse mortality. Therefore all patients initially scheduled for aSCT within a 25-month period were screened during pre-transplantation-routine for muscle mass, grip strength, and aerobic capacity (AC) by measuring peak oxygen uptake (VO2peak). Patients were assigned to one of five groups adapted according current sarcopenia guidelines. Primary endpoints were all-cause and non-relapse mortality within a follow up time of up to 12 months. A total of 178 patients were included and rated as normal (n = 48), impaired aerobic capacity (n = 56), pre-sarcopenic (n = 26), sarcopenic (n = 27), and severe sarcopenic (n = 22) without significant age-differences between groups. Patients presenting with sarcopenia showed a significant three-fold increase in all-cause and non-relapse mortality compared to patients with normal screening results. AC showed to be the strongest single predictor with a more than two-fold increase of mortality for low AC. We conclude that risk stratification based on combination of muscle mass, grip strength, and AC allowed identifying a subgroup with increased risk for complications in patients undergoing aSCT.