Body composition and phase angle as prognostic factors in adults with acute lymphoblastic leukemia

The prognostic role of body composition and phase angle (PhA) in adult patients with acute lymphoblastic leukemia (ALL) remains unclear. This study evaluates the impact of body composition parameters and PhA on overall survival (OS) and disease-free survival (DFS) in ALL patients receiving intensive chemotherapy.

We conducted a retrospective analysis of 81 adult ALL patients. Baseline body composition was assessed at ALL diagnosis and before therapy using bioelectrical impedance analysis (BIA), including body fat mass (BFM), fat mass index (FMI), fat-free mass (FFM), fat free mass index (FFMI), and PhA. Kaplan-Meier curves and log-rank tests were employed to compare survival outcomes across body composition and PhA categories. Cox regression was used for multivariate analysis to confirm findings.

The median age at diagnosis was 25 years (range: 16-67), with 56.8 % being male and 91.3 % having B-cell ALL. A significant association was observed between lower PhA (≤4°) and poorer OS (p = 0.02). Similarly, patients with a FFMI <16 kg/m² had inferior OS (p = 0.0163). A body mass index (BMI) ≥25 showed a trend toward worse OS but was not statistically significant. Multivariate Cox regression confirmed that PhA ≤4° (HR 3.148, 95%CI 1.55-6.27), hypoalbuminemia (HR 2.233, 95%CI 1.09-4.54), and very high-risk cytogenetics (HR 2.310, 95%CI 1.15-4.62) were independent prognostic factors for worse OS.

PhA and FFMI serve as prognostic markers in adult ALL patients. Lower PhA and reduced FFMI are associated with poorer survival, underscoring the need for early nutritional assessment and potential interventions. Further prospective studies are needed to validate these findings and explore best strategies of management.