Sarcopenia and sarcopenic obesity after chemotherapy in childhood lymphoma.

Sarcopenia and sarcopenic obesity are increasingly recognized sequelae of anticancer therapy in children, yet a consensus definition remains elusive. Diminished skeletal muscle area (SMA) and increased adiposity have been associated with poor outcomes in several pediatric malignancies, but data for childhood lymphoma, particularly in Thailand, are lacking. We retrospectively analyzed 73 children with lymphoma treated with chemotherapy (CMT) between 2004 and 2024 at a single institution. SMA and adiposity parameters were measured using computed tomography (CT) at the L4/L5 intervertebral disc level using in-house software developed in MATLAB and freeware Python 3.6.13. Sarcopenia and sarcopenic obesity were determined, and survival analysis was performed. The cohort’s mean age was 8.9 ± 3.7 years. The prevalence of sarcopenia was 60.3% based on the SMA change rate (< 9.12% per 6 months) and 67.1% based on the skeletal muscle index (SMI) change rate (< 8.46% per 6 months); 65.8% met the criteria for sarcopenic obesity. Patients with Hodgkin lymphoma (HL) were more likely than those with non-Hodgkin lymphoma (NHL) to exhibit sarcopenia (SMA: odds ratio [OR] = 6.32, 95% confidence interval [CI] 2.16–21.58; SMI: OR = 5.65, 95% CI 1.82–21.64) and sarcopenic obesity (OR = 4.35, 95% CI 1.48–14.80). However, sarcopenia and sarcopenic obesity were not significantly associated with survival outcomes. Post-CMT sarcopenia and sarcopenic obesity are more prevalent in HL than in NHL. Nevertheless, the change in sarcopenia and sarcopenic obesity parameters after treatment may not significantly influence long-term survival outcomes in children with lymphoma, potentially due to ongoing muscle growth during development.