Basic characteristics of patients
A total of 60 patients with diffuse large B-cell lymphoma were used for this study based on patient inclusion and exclusion criteria. The basic characteristics of the patients are as follows: 27 males and 33 females, with an average age of (55.83 ± 13.33) years. The distribution of clinical features among different hematological toxicity groups was balanced. See Table 1 for details.
Anthropometric Indicators
The BMI of the included patients was (23.21 ± 3.78) kg/m2, and the BMI of the patients with < 3 grade neutrophil count reduction group and ≥ 3 grade neutrophil count reduction group were (23.57 ± 4.02) kg/m2 and (22.73, respectively). ±3.45) kg/m2, the difference was not statistically significant. See Table 1 for details. The BMI of patients in the grade 3 leukopenia group and the grade 3 leukopenia group were (24.27 ± 4.26) kg/m2 and (21.73 ± 2.33) kg/m2, respectively, and the difference was statistically significant (P < 0.05). See Table 2 for details. The calculated BSA was (1.77 ± 0.36) m2, and the BSA of the < 3 grade neutrophil count reduction group and the ≥ 3 grade neutrophil count decrease group were (1.78 ± 0.36) m2 and (1.75 ± 0.37)m2, respectively. The difference was not statistically significant. See Table 1 for details. The BSA of the < 3 grade leukopenia group and the grade 3 leukopenia group were (1.81 ± 0.33) m2 and (1.71 ± 0.40) m2, respectively, and the difference was not statistically significant. See Table 2 for details.
Laboratory Test Indicators
According to patient test data, Alb was (38.37 ± 5.55) g/L. <3 grade neutrophil count reduction group was (38.58 ± 5.64) g/L, ≥ 3 grade neutrophil count reduction group was (38.09 ± 5.52) g/L, and the two groups of Alb were not statistically significant. See Table 1 for details. <3 grade leukopenia group was (39.43 ± 5.63) g/L, and grade 3 grade leukopenia group was (36.93 ± 5.20) g/L. There was no significant difference between the two groups. See Table 2 for details.
Body Composition Index
The slice CT image of the patient's abdomen was analyzed by sliceOmatic 5.0 software, and L3SMI and LBM were derived, which were (42.34 ± 8.79) cm2/m2, (40.54 ± 8.66) kg, respectively. <3 grade neutrophil count reduction group and ≥ 3 grade neutrophil count reduction group L3SMI were (44.79 ± 9.11) cm2/m2 and (39.13 ± 7.36) cm2/m2, ≥ 3 grade neutrophils, respectively. The L3SMI of patients with reduced count was significantly lower than that of patients with lower neutrophil counts than < 3, the difference was statistically significant (P < 0.05). See Table 1 and Fig. 1 for details. The L3SMI of the patients in the grade 3 leukopenia group and the grade 3 leukopenia group were (45.60 ± 9.23) cm2/m2 and (37.76 ± 5.67) cm2/m2, respectively. The patients with ≥ 3 grade leukopenia had significantly lower L3SMI than < 3 grade leukocytes. In the reduction group, the difference was statistically significant (P < 0.001). The LBM of the grade 3 neutrophil count reduction group and the ≥ 3 grade neutrophil count reduction group were (42.17 ± 8.84) kg and (38.41 ± 8.10) kg, respectively, and the difference was not statistically significant. The LBM of the grade 3 leukopenia group and the grade 3 leukopenia group were (43.31 ± 9.18) kg and (36.67 ± 6.19) kg, respectively, and the difference was statistically significant (P < 0.05). See Table 2 and Fig. 2 for details.
Table 1
General information on neutrophil count reduction and univariate analysis results
Relevant factors | Mean ± standard deviation | A | B | t | P |
Age | 55.8 ± 13.33 | 54.35 ± 15.15 | 57.77 ± 10.48 | -0.98 | 0.330 |
LBM | 40.54 ± 8.66 | 42.17 ± 8.84 | 38.41 ± 8.10 | 1.69 | 0.097 |
L3SMI | 42.34 ± 8.79 | 44.79 ± 9.11 | 39.13 ± 7.36 | 2.59 | 0.012 |
BSA | 1.77 ± 0.36 | 1.78 ± 0.36 | 1.75 ± 0.37 | 0.34 | 0.735 |
BMI | 23.21 ± 3.78 | 23.57 ± 4.02 | 22.73 ± 3.45 | 0.85 | 0.398 |
Alb | 38.37 ± 5.55 | 38.58 ± 5.64 | 38.09 ± 5.52 | 0.33 | 0.740 |
Creatinine | 68.9 ± 18.27 | 67.87 ± 15.41 | 70.39 ± 21.61 | -0.52 | 0.603 |
Urea nitrogen | 5.61 ± 2.13 | 5.53 ± 2.01 | 5.71 ± 2.32 | -0.40 | 0.692 |
AST | 24.71 ± 8.18 | 25.38 ± 7.83 | 23.85 ± 8.67 | -0.32 | 0.754 |
ALT | 21.0 ± 13.44 | 23.19 ± 15.70 | 18.33 ± 9.46 | 1.39 | 0.170 |
Cholinesterase | 7637.71 ± 2545.01 | 7809.36 ± 2475.30 | 6855.26 ± 2613.11 | 1.18 | 0.245 |
A: < Class 3 hematological toxicity;B: < Grade 3 hematological toxicity |
Table 2
General information on leukopenia and univariate analysis results
Relevant factors | Mean ± standard deviation | A | B | t | P |
Age | 55.83 ± 13.33 | 53.37 ± 14.39 | 59.28 ± 11.06 | -1.72 | 0.091 |
LBM | 40.54 ± 8.66 | 43.31 ± 9.18 | 36.67 ± 6.19 | 3.347 | 0.001 |
L3SMI | 42.34 ± 8.79 | 45.60 ± 9.23 | 37.76 ± 5.67 | 4.07 | < 0.001 |
BSA | 1.77 ± 0.36 | 1.81 ± 0.33 | 1.71 ± 0.40 | 1.14 | 0.261 |
BMI | 23.21 ± 3.78 | 24.27 ± 4.26 | 21.73 ± 2.33 | 2.97 | 0.004 |
Alb | 38.37 ± 5.55 | 39.43 ± 5.63 | 36.93 ± 5.20 | 1.74 | 0.087 |
Creatinine | 68.98 ± 18.27 | 68.49 ± 15.72 | 69.66 ± 21.60 | -0.24 | 0.810 |
Urea nitrogen | 5.61 ± 2.13 | 5.52 ± 2.02 | 5.74 ± 2.31 | -0.40 | 0.692 |
AST | 24.71 ± 8.18 | 24.62 ± 7.63 | 24.84 ± 9.04 | -0.10 | 0.920 |
ALT | 21.05 ± 13.44 | 23.96 ± 15.51 | 17.08 ± 8.79 | 2.16 | 0.036 |
Cholinesterase | 7292.±2545.01 | 7809.2 ± 2380.80 | 6590.2 ± 2639.56 | 1.86 | 0.069 |
Multivariate Analysis Results
Univariate analysis of neutrophil counts showed that L3SMI was associated with a decrease in grade 3 ~ 4 neutrophil counts, age, BMI, BSA, Alb, LBM, creatinine, urea nitrogen, ALT, AST, choline esters. The enzyme is not associated with a decrease in neutrophil count. Multivariate logistic regression analysis was performed on the factors affecting the reduction of grade 3 ~ 4 neutrophil count. The inclusion factors included L3SMI, BMI, Alb, creatinine, urea nitrogen, AST, ALT, cholinesterase. The results showed: L3SMI Statistically significant, it is an independent predictor of decreased neutrophil count in patients with diffuse large B-cell lymphoma treated with the CHOP ± R regimen. The risk of chemotherapy-related grade 3–4 neutrophil count was significantly higher in patients with low L3SMI than in the control group (OR: 0.893, 95% CI [0.818–0.975], P = 0.012). See Table 3 for details. Univariate analysis of leukopenia showed that L3SMI, LBM, BMI, and ALT were associated with grade 3–4 leukopenia. Age, BSA, Alb, creatinine, urea nitrogen, AST, and cholinesterase were not associated with leukopenia. Multivariate logistic regression analysis was performed on the factors affecting the occurrence of grade 3 ~ 4 leukopenia. The inclusion factors included L3SMI, BMI, Alb, creatinine, urea nitrogen, AST, ALT, and cholinesterase. The results showed that L3SMI was statistically significant. Is an independent predictor of leukopenia in patients with diffuse large B-cell lymphoma treated with the CHOP ± R regimen. The risk of chemotherapy-related grade 3–4 leukopenia was significantly higher in patients with low L3SMI than in the control group (OR: 0.871, 95% CI [0.785–0.966], P = 0.009). See Table 4 for details.
Table 3
Logistic multivariate analysis results of neutrophil count reduction of grade ≥ 3
Variables | β | SE | Wald | P | OR | 95%CI |
Lower | Upper |
L3SMI | -0.113 | 0.045 | 6.368 | 0.012 | 0.893 | 0.818 | 0.975 |
BMI | 0.066 | 0.097 | 0.454 | 0.500 | 1.068 | 0.882 | 1.292 |
Alb | 0.059 | 0.069 | 0.730 | 0.393 | 1.061 | 0.926 | 1.215 |
Creatinine | 0.031 | 0.024 | 1.599 | 0.206 | 1.031 | 0.983 | 1.081 |
Urea nitrogen | -0.128 | 0.208 | 0.382 | 0.537 | 0.880 | 0.585 | 1.322 |
AST | 0.008 | 0.045 | 0.028 | 0.867 | 1.008 | 0.923 | 1.100 |
ALT | -0.016 | 0.030 | 0.293 | 0.588 | 0.984 | 0.927 | 1.044 |
Cholinesterase | 0 | 0 | 2.031 | 0.154 | 1 | 0.999 | 1.000 |
Table 4
Logistic Multivariate Analysis Results for Leukopenia of Grade ≥ 3
Variables | β | SE | Wald | P | OR | 95%CI |
Lower | Upper |
L3SMI | -0.138 | 0.053 | 6.789 | 0.009 | 0.871 | 0.785 | 0.966 |
BMI | -0.092 | 0.119 | 0.604 | 0.437 | 0.912 | 0.723 | 1.151 |
Alb | 0.015 | 0.076 | 0.038 | 0.845 | 1.015 | 0.875 | 1.177 |
Creatinine | 0.050 | 0.028 | 3.163 | 0.075 | 1.052 | 0.995 | 1.111 |
Urea nitrogen | -0.332 | 0.242 | 1.875 | 0.171 | 0.718 | 0.447 | 1.154 |
AST | 0.083 | 0.054 | 2.364 | 0.124 | 1.086 | 0.977 | 1.207 |
ALT | -0.050 | 0.038 | 1.727 | 0.189 | 0.951 | 0.883 | 1.025 |
Cholinesterase | 0 | 0 | 2.127 | 0.145 | 1 | 0.999 | 1.000 |
Diagnostic value of different body composition indicators for grade 3 ~ 4 hematological toxicity
According to the results of multivariate logistic regression analysis, L3SMI is an independent predictor of decreased neutrophil count and leukopenia in patients with diffuse large B-cell lymphoma treated with CHOP ± R regimen. According to the reduction of ≥ 3 grade neutrophil count as the cut-point value, ROC analysis of BMI, BSA, L3SMI, LBM, Alb, creatinine, urea nitrogen, ALT, AST, cholinesterase reduced the absolute value of neutrophils Diagnostic value. The area under the L3SMI curve was 0.681, P = 0.018. L3SMI has a good diagnostic effect on the reduction of neutrophil count. In addition, the ROC curve analysis showed that the ≥ 3 grade neutrophil count decreased and the < 3 grade neutrophil count reduction group had a L3SMI cutoff value of 39.91 cm2/m2, and its sensitivity was 0.65, and the specificity was 0.70. See Fig. 3, Table 5 and Table 6 for details. According to ≥ 3 grade leukopenia as the cut-point value, ROC curve was used to analyze the diagnostic value of BMI, BSA, L3SMI, LBM, Alb, creatinine, urea nitrogen, ALT, AST and cholinesterase on leukopenia. The area under the L3SMI curve is 0.74, P = 0.002. The area under the LBM curve was 0.705, P = 0.007. L3SMI and LBM have a good diagnostic effect on leukopenia. In addition, the ROC curve analysis showed that the critical values of L3SMI and LBM of ≥ 3 leukopenia and < 3 grade leukopenia were 39.91 cm2/m2, 40.50 kg, the sensitivity of L3SMI was 0.68, and the specificity was 0.71. The sensitivity is 0.80 and the specificity is 0.56. See Fig. 4, Table 7 and Table 8 for details.
Table 5
ROC curve value for ≥ 3 grade neutrophil count reduction
Relevant factors | AUC | Standard error | P | 95% | Confidence interval |
L3SMI | 0.681 | 0.07 | 0.018 | 0.54 | 0.82 |
BMI | 0.576 | 0.08 | 0.321 | 0.43 | 0.72 |
BSA | 0.505 | 0.08 | 0.95 | 0.35 | 0.66 |
LBM | 0.622 | 0.07 | 0.111 | 0.48 | 0.77 |
Alb | 0.529 | 0.08 | 0.703 | 0.38 | 0.68 |
Creatinine | 0.485 | 0.08 | 0.843 | 0.33 | 0.64 |
Urea nitrogen | 0.496 | 0.08 | 0.957 | 0.35 | 0.65 |
AST | 0.581 | 0.08 | 0.29 | 0.43 | 0.73 |
ALT | 0.568 | 0.08 | 0.372 | 0.42 | 0.72 |
Cholinesterase | 0.540 | 0.08 | 0.60 | 0.39 | 0.69 |
Table 6
Threshold, sensitivity and specificity of neutrophil count reduction of grade ≥ 3
Relevant factors | Threshold | Sensitivity | Specificity |
L3SMI | 39.91 | 0.65 | 0.70 |
BMI | 26.52 | 0.92 | 0.27 |
BSA | 1.67 | 0.35 | 0.79 |
LBM | 35.50 | 0.42 | 0.79 |
Alb Creatinine Urea nitrogen AST ALT | 33.50 51 5.8 24.05 40.6 | 0.27 0.19 0.77 0.73 1.00 | 0.85 0.91 0.36 0.55 0.18 |
Cholinesterase | 5909 | 0.35 | 0.85 |
Table 7
ROC curve value of ≥ 3 leukopenia
Relevant factors | AUC | Standard error | P | 95% | Confidence interval |
L3SMI | 0.74 | 0.06 | 0.002 | 0.62 | 0.87 |
BMI | 0.689 | 0.07 | 0.14 | 0.56 | 0.82 |
BSA | 0.541 | 0.08 | 0.59 | 0.39 | 0.70 |
LBM | 0.705 | 0.07 | 0.007 | 0.574 | 0.84 |
Alb | 0.646 | 0.07 | 0.056 | 0.50 | 0.79 |
Creatinine | 0.511 | 0.08 | 0.890 | 0.36 | 0.66 |
Urea nitrogen | 0.482 | 0.08 | 0.818 | 0.33 | 0.63 |
AST | 0.512 | 0.08 | 0.88 | 0.36 | 0.66 |
ALT | 0.621 | 0.07 | 0.12 | 0.48 | 0.76 |
Cholinesterase | 0.608 | 0.08 | 0.16 | 0.46 | 0.76 |
Table 8
Threshold, sensitivity and specificity of ≥ 3 leukopenia
Relevant factors | Threshold | Sensitivity | Specificity |
L3SMI | 39.91 | 0.68 | 0.71 |
BMI | 22.98 | 0.72 | 0.62 |
BSA | 1.67 | 0.40 | 0.82 |
LBM | 40.50 | 0.80 | 0.56 |
Alb | 40.65 | 0.76 | 0.50 |
Creatinine | 67.85 | 0.60 | 0.53 |
Urea nitrogen | 5.80 | 0.76 | 0.35 |
AST | 24.05 | 0.68 | 0.50 |
ALT | 14.40 | 0.56 | 0.68 |
Cholinesterase | 5909 | 0.40 | 0.88 |