Sarcopenia and fat loss from serial CT predict survival in multiple myeloma patients undergoing stem cell transplantation

Abstract Background Frailty and sarcopenia are associated with adverse outcomes in multiple myeloma (MM), but their longitudinal changes and clinical relevance remain unclear. This study evaluated the longitudinal changes in body composition parameters derived from computed tomography (CT) scans and their association with survival and functional decline in MM patients undergoing autologous stem cell transplantation (ASCT). Methods We analyzed 49 MM patients who underwent three sequential CT scans between 2009 and 2024. CT-based body composition parameters—skeletal muscle index (SMI), paraspinal muscle index (PSMI), psoas muscle index (PMI), skeletal muscle density (SMD), and visceral adipose tissue (VAT)—were measured at the L3 level. Changes in these parameters were assessed over the disease course, and their impact on survival and functional outcome was evaluated using Cox proportional hazards regression models and Kaplan–Meier survival analyses. Results CT morphometric body composition parameters declined significantly over time in both sexes. In males, SMI decreased from 48.6 ± 7.1 to 38.4 ± 8.1 cm 2 /m 2 (–21%, p < 0.0001); in females, from 36.6 ± 7.8 to 26.9 ± 4.7 cm 2 /m 2 (–26%, p < 0.0001). VAT declined from 115.9 ± 9.1 to 84.9 ± 9.7 cm 2 in males (–27%, p < 0.0001) and from 63.5 ± 7.1 to 42.1 ± 7.7 cm 2 in females (–34%, p < 0.0001). Patients < 55 years showed comparable declines (e.g., male SMI –21%, VAT –57%). High disease activity was associated with greater SMI (–31.1% vs. –15.5%, p < 0.001) and VAT (–33.5% vs. –26.5%, p < 0.01) losses versus low activity. ASCT patients had larger declines (SMI –31.1% vs. –15.4%, p < 0.001; VAT –33.4% vs. –27.5%, p < 0.01). Cox regression identified reductions in SMI (HR 1.40, 95% CI 1.10–2.20, p = 0.012) and VAT (HR 1.90, 95% CI 1.40–2.90, p = 0.002) as independent predictors of reduced survival. Patients with SMI loss ≥ 10% or VAT loss ≥ 12% had significantly shorter survival (SMI: 80.2 vs. 110.2 months, p = 0.01; VAT: 84.3 vs. 109.4 months, p < 0.01) and greater functional decline, with ECOG worsening from 1 to 3 ( p < 0.0001). Conclusion Longitudinal changes in SMI and VAT were significant predictors of survival and functional decline in MM patients undergoing ASCT. Routine CT-based body composition assessments might serve as valuable tools for additional risk stratification and potential targeted interventions. These findings underscore the importance of integrating body composition analysis into clinical practice for improved risk stratification and potential implementation of early intervention strategies.