CT-Based body composition and nutritional status as predictors of early-treatment chemotherapy-related infections and hematologic toxicity in pediatric cancer: a prospective study.

Low skeletal muscle mass (SMM) and skeletal muscle index (SMI) were correlated with higher risk of infection in pediatric cancer patients.

• Low SMM was associated with infection risk with OR 4.20 (95% CI 1.23–14.27)
• Low SMI was associated with infection risk with OR 3.92 (95% CI 1.17–13.20)
• Associations were analyzed using χ2 tests and logistic regression adjusted for sex, age, tumor stage, and type
• These associations were identified in the unadjusted analysis

Low SMM and SMI were correlated with higher risk of fever in pediatric cancer patients.

• Low SMM was associated with fever with OR 4.05 (95% CI 1.21–13.54)
• Low SMI was associated with fever with OR 5.82 (95% CI 1.67–20.25)
• These associations were identified in unadjusted logistic regression models

After multivariable adjustment, only low SMI remained independently associated with fever.

• Adjusted OR for low SMI and fever was 4.74 (95% CI 1.09–20.61; p = 0.038)
• Model was adjusted for sex, age, tumor stage, and tumor type
• Low SMM did not retain independent significance after adjustment
• This was identified as the primary independent predictor among CT-derived parameters

No association was found between anthropometric parameters or handgrip strength (HGS) and chemotherapy-related toxicities.

• Anthropometric data collected included weight, height, arm circumference, and triceps skinfold thickness
• HGS was measured and analyzed as a predictor of toxicity outcomes
• Neither anthropometric measures nor HGS were significantly associated with infection, fever, or hematologic toxicity
• The authors noted this indicates further studies are needed

The study cohort consisted of 48 pediatric cancer patients with predominantly hematologic malignancies and advanced disease.

• Mean age was 12.6 ± 3.3 years; 64.6% were male
• 64.6% had hematologic malignancies
• 53.6% had advanced disease
• Most patients were classified as having normal nutritional status (50–64.6% depending on the assessment method used)
• Patients were aged 7–18 years and required available CT or PET-CT scans for inclusion

Hematologic and gastrointestinal toxicities were the most frequent treatment-related toxicities observed.

• Hematologic toxicity occurred in 100% of patients
• Gastrointestinal toxicity occurred in 85.4% of patients
• Toxicity was assessed during early chemotherapy treatment
• The study was a prospective observational cohort design

CT-derived body composition was measured at the third and fourth lumbar vertebral levels.

• Skeletal muscle mass (SMM), skeletal muscle index (SMI), total adipose tissue, and muscle radiodensity were measured at the third lumbar vertebra (L3)
• Psoas muscle area was assessed at the fourth lumbar vertebra (L4)
• CT or PET-CT scans were used for body composition analysis
• Muscle radiodensity and total adipose tissue were among the parameters evaluated but were not independently associated with outcomes after adjustment