Is Phase Angle Useful in Screening for Sarcopenia in Patients with Hematologic Malignancies?

The purposes of this study were to investigate the relationship between sarcopenia and phase angle (PhA), and to examine whether PhA cutoff values can be used to identify sarcopenia in patients with hematologic malignancies. The study population comprised 108 patients with hematologic malignancies who were admitted for chemotherapy, and were undergoing rehabilitation for exercise therapy. The diagnostic criteria for sarcopenia were determined according to the Asian Working Group for Sarcopenia 2019. Muscle strength, endurance, and body composition (including PhA), were assessed. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to investigate associations between sarcopenia and PhA, and to determine cutoff values. Sarcopenia was found in 17.6% of the participants. PhA was significantly associated with sarcopenia (p < 0.01). The areas under the curve were 0.84 for the males and 0.87 for the females, and the cutoff values were 4.75° for the males (sensitivity 69%, specificity 83%) and 3.95° for the females (sensitivity 78%, specificity 85%). Our results suggest that PhA, which can be measured noninvasively, objectively, and rapidly, can be used as a screening tool for sarcopenia in patients with hematologic malignancies.

Biosyntheses of geranic acid and citronellic acid from monoterpene alcohols by Saccharomyces cerevisiae.

Geraniol is one of the important aromatic ingredients in alcoholic beverages. Bioconversions of geraniol to other terpenoids and genes involved in the oxidation of geraniol were investigated. Geranic acid and citronellic acid were detected in yeast culture, where geraniol or nerol was added. Addition of citral, a mixture of geranial and neral, resulted in the production of geranic acid and citronellic acid, whereas the addition of citral or citronellal resulted in the production of citronellic acid, suggesting that citronellic acid might be produced through the conversion of citral to citronellal followed by the oxidation of citronellal. Consumption of geraniol and production of geranic acid, citronellic acid, and citronellol were affected in adh1Δ, adh3Δ, adh4Δ, and sfa1Δ yeast strains, which possess single deletion of a gene encoding alcohol dehydrogenase. This is the first report of the bioconversion of monoterpene alcohols, geraniol and nerol, to geranic acid and citronellic acid in yeast culture.

Novel prognostic index based on hemoglobin level and platelet count for diffuse large B-cell lymphoma, not otherwise specified in the R-CHOP era.

The international prognostic index (IPI) is a broadly utilized clinical tool to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphomas (NHL). However, since this score was developed before the development of rituximab, and the introduction of combined rituximab plus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) (R-CHOP) therapy for NHL has dramatically improved clinical outcomes, the IPI may be inadequate to assess prognosis in the R-CHOP era. In the present study, we assessed the utility of hemoglobin (Hb) level and platelet count to predict prognosis in diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), the largest category of aggressive NHL. A total of 89 patients newly diagnosed with nodal DLBCL, NOS and treated with R-CHOP therapy were included. The blood count results at diagnosis were statistically analyzed. Available biopsy specimens were immunostained for interleukin (IL)-6. Hb levels lower than 120 g/L (p = 0.0133) and platelet counts lower than 135 × 109/L (p = 0.0233) were associated with worse overall survival (OS). Based on those levels as cutoff values, a hemoglobin-platelet (HP) index was calculated by assigning 1 point for an Hb level or a platelet count lower than the cutoff. The patients were divided into three groups based on the HP index: high, with a score of 2 (n = 8); intermediate, with a score of 1 (n = 39); and low, with a score of 0 (n = 42). A higher HP index was associated with worse OS (p = 0.0055). Patients with IL-6-positive tumors had significantly lower Hb levels than those with IL-6-negative tumors (p = 0.0264), suggesting that abnormal production of IL-6 by lymphoma cells is associated with anemia. On the other hand, there was no association between the platelet counts and the IL-6 expression in the lymphoma cells. In a multivariate analysis, the HP index predicted OS rate independently of the IPI. Since the HP index is based on inexpensive and broadly available laboratory values, we believe that this index will have great utility in clinical practice, and the addition of this index to IPI could more precisely predict prognosis.

Impact of Sarcopenia on Outcome of Exercise Therapy in Older Non-Hodgkin Lymphoma Patients.

PURPOSE: The aim of this study was to investigate the effects of exercise therapy on physical function and quality of life (QOL) in older patients with non-Hodgkin lymphoma undergoing inpatient chemotherapy, including differences between patients with and without sarcopenia. METHODS: Thirty-one inpatients aged 70 years or older participated in this study. Grip and knee extensor strength, 6-minute walking test, body composition, nutritional status, fatigue and health-related QOL at admission and discharge were compared. In addition, the patients were classified into sarcopenic and non-sarcopenic groups, and a comparison between admission and discharge and 2-way ANOVA were performed. RESULTS: Overall, grip strength and skeletal muscle mass were significantly lower at discharge than at admission (P < .05); however, QOL significantly improved (P < .05). In the non-sarcopenia group, grip strength, right knee extension muscle strength, and skeletal muscle mass were all significantly lower at discharge than at admission (P < .05); however, this was not the case in the sarcopenia group. In terms of QOL, improvements were observed in different items in the non-sarcopenia and sarcopenia groups. There was a significant interaction between admission to discharge time period and sarcopenia regarding left grip strength, right knee extensor strength, and QOL. CONCLUSION: Exercise therapy is effective in improving QOL in older non-Hodgkin lymphoma patients undergoing inpatient chemotherapy. However, the effect of exercise therapy and optimal exercise load may differ between non-sarcopenia and sarcopenia patients. Therefore, it is necessary to consider exercise therapy in the future, taking into account the presence or absence of sarcopenia.

Tumor necrosis factor- and interleukin-6-producing high-grade B-cell lymphoma, not otherwise specified in the pleura.

A 65-year-old man was admitted to our hospital with left-sided chest and back pain and dyspnea. Computed tomography demonstrated a marked circumferential left pleural thickening. A thoracoscopic pleural biopsy led to a diagnosis of high-grade B-cell lymphoma, not otherwise specified (HGBL, NOS). Lymphoma cells were positive for tumor necrosis factor (TNF) and interleukin-6. This is the first case report of TNF- and IL-6-producing aggressive HGBL, NOS in the pleura, in which radiological findings mimicked pleural mesothelioma. The aggressive tumor progression in the present case may have been caused by abnormal cytokine production from lymphoma cells.