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The Prognostic Significance of Sarcopenia Assessed by the Psoas Muscle Index in Multiple Myeloma Patients
Ebru Kilic Gunes1, Koray Kaya Kilic2, Meltem Ayli1
1Department of Hematology, Gulhane Training and Research Hospital, University of Health and Sciences, Ankara, Türkiye.
Abstract:
Sarcopenia, defined as a loss of skeletal muscle mass and/or function, has been associated with poor survival in various cancers. This study evaluates the prognostic impact of sarcopenia in multiple myeloma (MM) using the Psoas Muscle Index (PMI). A total of 181 MM patients diagnosed between 2014 and 2024 were retrospectively analyzed. Sarcopenia was assessed using PMI measurements at the L3 vertebra level, with gender-specific cut-off values determined by ROC analysis (442.63 mm²/m² for males and 308.85 mm²/m² for females). Sarcopenia was identified in 29.8% of patients. Sarcopenic patients were significantly older, had lower BMI, albumin, and hemoglobin levels, and were less likely to be eligible for transplantation. Multivariate analysis revealed that older age (OR:1.14, 95%CI:1.08-1.32, p = 0.014), hypoalbuminemia (OR:2.13, 95% CI: 1.11-4.12, p = 0.023), and low BMI (OR:2.52, 95%CI:1.83-5.23, p = 0.001) were independent risk factors for sarcopenia. Sarcopenia independently predicted worse PFS (HR:1.628, 95%CI:1.065-2.487, p = 0.024) and OS (HR:2.095, 95%CI:1.207-3.636, p = 0.009). Other independent risk factors for OS included LDH > ULN (HR:2.026, 95%CI:1.130-3.631, p = 0.018), transplant eligibility (HR:0.338, 95%CI:0.191-0.596, p < 0.001), and high cytogenetic risk (HR:1.912, 95%CI:1.004-3.640, p = 0.049). Subgroup analyses showed that sarcopenia significantly affected OS in transplant-ineligible patients (HR:0.501, 95%CI: 0.262-0.957, p = 0.03) but had no significant impact on survival in transplant-eligible patients. Sarcopenia analysis by using PMI in MM patients can be considered a cost-effective, simple, easily applicable, and practical method for daily routine. Sarcopenia independently predicts worse survival outcomes, particularly in transplant-ineligible patients. Larger prospective studies are warranted to validate these findings and explore integrating sarcopenia into frailty indices for MM.
Insights
Sarcopenia, a loss of muscle mass, is linked to poorer survival in multiple myeloma (MM) patients. This study found sarcopenia independently predicts worse progression-free and overall survival, especially in those ineligible for transplantation.
Area of Science:
- Oncology
- Geriatrics
- Radiology
Background:
- Sarcopenia, characterized by skeletal muscle mass and/or function loss, is a known predictor of poor outcomes in various cancers.
- Its prognostic significance in multiple myeloma (MM) requires further elucidation.
Purpose of the Study:
- To evaluate the prognostic impact of sarcopenia, assessed via Psoas Muscle Index (PMI), in patients with multiple myeloma.
- To identify risk factors associated with sarcopenia in MM patients and analyze its effect on survival outcomes.
Main Methods:
- Retrospective analysis of 181 MM patients diagnosed between 2014 and 2024.
- Sarcopenia assessment using L3 vertebral level PMI measurements with gender-specific cut-offs derived from ROC analysis.
- Multivariate analyses to determine independent predictors of sarcopenia and survival (Progression-Free Survival [PFS] and Overall Survival [OS]).
Main Results:
- Sarcopenia was identified in 29.8% of patients, who were older with lower BMI, albumin, and hemoglobin, and less transplant-eligible.
- Independent risk factors for sarcopenia included older age, hypoalbuminemia, and low BMI.
- Sarcopenia independently predicted worse PFS and OS. Other OS predictors were elevated LDH, transplant eligibility, and high cytogenetic risk.
- Sarcopenia significantly impacted OS in transplant-ineligible patients but not in transplant-eligible ones.
Conclusions:
- Psoas Muscle Index (PMI) is a practical method for sarcopenia assessment in MM patients.
- Sarcopenia is an independent negative prognostic factor for survival in MM, particularly in transplant-ineligible individuals.
- Further prospective studies are recommended to validate these findings and integrate sarcopenia into frailty assessments for MM.
