Changes In body composition and subsequent risk of relapse In childhood hodgkin lymphoma.
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BACKGROUND: Whether changes in body composition (skeletal muscle and adipose tissue, measured using computed tomography [CT] scans) are associated with relapse in children with Hodgkin lymphoma (HL) remains unknown. METHODS: We examined changes in body composition (skeletal muscle area [SMA] and total adipose tissue [TAT] area) of children with intermediate- and high-risk HL enrolled on Children's Oncology Group trials AHOD0031 and AHOD0831 using commercially available software from pre-treatment to after two cycles of chemotherapy. SMA or TAT values exceeding the median increase were classified as excessive gain, and those exceeding the median decline were classified as excessive loss in SMA or TAT. Proportional sub-distribution hazard regression models examined the association between change in body composition and relapse from end of cycle 2 treating non-relapse-related death as competing risk and adjusting for prognosticators including baseline SMA and TAT. RESULTS: Among the 951 children included in this analysis, the median age at diagnosis was 15.2y, 53.8% were male and 63.5% were non-Hispanic White. Excessive gain in TAT (observed in 36.2%) was associated with a 1.73-fold greater adjusted hazard of relapse (95% confidence interval [CI]=1.08-2.77, P=0.02) among children with negative PET2, but not among those with positive PET2 (hazard ratio [HR]=0.90, 95%CI=0.51-1.57, P=0.70) after adjusting for prognosticators. Excessive change in SMA was not associated with relapse. CONCLUSIONS: This candidate biomarker is associated with an increased risk of relapse and presents a need to understand the underlying mechanisms for this association.