Body Composition Analysis Predicts Survival in Patients With Cancer and cGVHD
Researchers have identified high body fat percentage, as measured by CT imaging, as an independent predictor of mortality in patients with cancer who develop chronic graft vs host disease (cGVHD) following allogeneic hematopoietic cell transplantation (HCT).
The single-center study evaluated 113 patients treated between 2005 and 2016 who had undergone CT scans around the time of cGVHD diagnosis. Participants had a mean age of 51 years and were predominantly male (63%). Nearly all had a diagnosis of non-Hodgkin lymphoma, and cGVHD severity was classified as mild in 49%, moderate in 38%, and severe in 13%.
Researchers assessed body composition by analyzing CT scans at the third lumbar (L3) and fourth thoracic (T4) vertebrae to quantify skeletal muscle index (SMI), fat index (FI), and skeletal muscle density. A CT scan obtained a median of 77 days after HCT was used for analysis.
In multivariate analysis, a body fat percentage of 35% or higher was significantly associated with increased mortality risk, with a hazard ratio of 2.094. This association was especially evident in male patients, who tended to have higher fat indices. Other metrics, including SMI, low skeletal muscle density, sarcopenic obesity, and body mass index (BMI), were not significantly linked to survival outcomes.
The findings suggest that radiographic measures of adiposity may offer valuable prognostic information in the context of cGVHD, where risk is typically assessed based on clinical severity, comorbidities, and functional decline. These results contrast with prior studies in other cancer populations, where muscle depletion has been more prominently associated with poor outcomes.
Exploratory analyses using thoracic CT scans at the T4 level produced similar results, raising the potential for broader application in post-transplant care, particularly given the routine use of chest imaging in these patients.
Reference
Mishra A, Thapa R, Bigam K, et al. Body composition assessment provides prognostic information in patients with cancer affected by chronic graft vs. host disease. J Cachexia Sarcopenia Muscle. 2025;16(2):e13759. doi: 10.1002/jcsm.13759
