Otolog Hematopoietik Kök Hücre Nakli Yapılan Hastalarda BT/PET-BT ile Sarkopeni Varlığının Değerlendirilmesi ve Prognostik Öneminin Araştırılması

Abstract

Coşkunpınar M. Evaluation of the Presence of Sarcopenia with CT/PET-CT and Investigation of its Prognostic Importance in Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation, Hacettepe University Faculty Of Medicine,Thesis of Specialization in Internal Medicine, Ankara, 2023. In this study, it was aimed to evaluate the frequency of sarcopenia by abdominal computed tomography/positron emission tomography taken before transplantation in patients with hematological or solid tumors who underwent autologous transplantation and to evaluate retrospectively the relationship between sarcopenia and prognosis. 139 patients who met the criteria were included in the study. 121 patients (87,1%) had hematological and 18 (12,9%) solid malignancies. While 101 patients (72,7%) were in the advanced stage at the time of diagnosis, 38 patients (27,3%) were in the early stage. It was found that the presence of advanced cancer at the time of diagnosis increases the risk of developing sarcopenia (HR: 2,374, 95% CI: 1,374-4,103, p=0,002), and a rise in body mass index was protective against sarcopenia (HR: 0,934, 95% CI: 0,889-0,980, p =0,006). Presence of sarcopenia before transplantation was not associated with overall survival in the entire cohort (p=0,139); however, the presence of sarcopenia before transplantation was associated with shorter overall survival in male patients ( HR: 1,971, 95% CI: 1,022-3,802, p=0,043 ) . Pre-transplantation sarcopenia (HR: 1,848, 95% CI: 1,127-3,029, p=0,015), presence of solid tumors ( HR: 2,732, 95% CI: 1,434-5,205, p=0,002 ) and a history of intensive care unit stay at follow-up ( HR: 2,457, 95% CI: 1,446-4,175, p=0,001 ) in the entire cohort was found to be associated with shorter progression-free survival. It was found that solid tumor, high procalcitonin and low albumin before transplantation, neutropenic fever on hospital stay and a history of intensive care hospitalization were associated with shorter overall survival. Pre-transplant sarcopenia (HR: 2,888, 95% CI: 1,071- 7,888, p=0,036) and hypoalbuminemia (HR: 3,093, 95% CI: 1,302-7,348, p=0,011) were discovered to increase the risk of septic shock-related death. This is the first study in which the effect of sarcopenia on prognosis was investigated, including patients with solid tumors who underwent autologous transplantation. In conclusion, sarcopenia prior to autologous transplantation is a significant factor that shortens progression-free survival, raises the risk of septic shock-related death and affects prognosis. Sarcopenia assessment during pre-transplant imaging may support clinical judgment and predict the prognosis of the transplant.