Body Composition in Patients with Follicular Lymphoma: Asso-Ciations between Changes in Radiomic Parameters in Patients Treated with R-CHOP-like and R-B Regimens: LyRa 01F

SIMPLE SUMMARY: In this study, we assessed changes in bone mineral density at disease onset and at the end of therapy in follicular lymphoma patients treated with R-CHOP and R-Bendamustine regimens. Another aim was to assess whether low bone mineral density at the onset of the disease is an unfavorable prognostic index. We also evaluated changes in other radiomic parameters, such as the musculoskeletal index, visceral adipose tissue, and subcutaneous adipose tissue in patients treated with R-Bendamustine and R-CHOP, with the latter containing high doses of steroids, which we know are associated with negative bone balance, a loss of muscle mass, and metabolic and cardiovascular issues. This is particularly relevant in elderly patients, in whom these changes could have an important impact on outcomes and the quality of life. As R-CHOP and R-Bendamustine are two effective treatment regimens in follicular lymphoma, this study, together with other clinical-laboratory parameters, could help in the choice of therapy. ABSTRACT: In patients with follicular lymphoma (FL), therapeutic advances have led to improved survival, and within this framework, it is important to identify treatment strategies offering a better quality of life. Using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), in patients treated with R-CHOP-like or R-Bendamustine regimens, we assessed changes in the bone mineral density (BMD), musculoskeletal index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at disease onset and at the end of therapy. We evaluated whether the high-steroid regimen could lead to more significant radiological changes than those induced by the steroid-free regimen and whether a low BMD at disease onset is an unfavorable prognostic index. Seventy-nine patients between 60 and 80 years old with a new diagnosis of FL were included in the study. Evaluation of Delta values (pre- and post-therapy mean values) in the two immunochemotherapy regimens showed differences in radiomic parameters within the two patient cohorts. The R-CHOP-like regimen was associated with a significant reduction in BMD, an increase in SAT and VAT, and a reduction in skeletal muscle density (SMD) and SMI. Moreover, patients with high FLIPI showed a BMD below the cut-off value. This study represents the first study demonstrating a prognostic correlation between FLIPI and low BMD.