# Sarcopenia in Older Adults with Hematologic Malignancies: A Comprehensive Review of Epidemiology, Prognosis, and Interventions

## TL;DR

This paper reviews how muscle loss (sarcopenia) affects older adults with blood cancers and its impact on treatment and outcomes.

## Contribution

The paper provides a comprehensive review of sarcopenia in hematologic malignancies, an area less studied compared to solid tumors.

## Key findings

- Sarcopenia is more common in older adults with blood cancers and is linked to worse treatment tolerance and survival.
- Most research on sarcopenia in cancer has focused on solid tumors, leaving a gap in knowledge for blood cancers.
- Nutrition and exercise may help manage sarcopenia, but evidence in cancer patients is limited.

## Abstract

Blood cancers include leukemias, lymphomas, and multiple myeloma. Blood cancers are diseases of older adults (age ≥ 60 years). As the human body ages, the amount of muscle and the strength of that muscle begin to decline. When muscle quantity and muscle strength are low enough, this is called sarcopenia. Over the past twenty years, the field of oncology has recognized that patients with cancer are affected with sarcopenia more often than those who do not have cancer. Furthermore, sarcopenia puts cancer patients at risk for tolerating cancer treatments poorly and passing away from their cancer earlier than those without sarcopenia. Much of what is published on the topic of sarcopenia in older adults with cancer has focused on cancers of the lung, breast, and colon. To fill this gap in knowledge, we provide a comprehensive review of the available information on sarcopenia among older adults with blood cancers. We describe the definition of sarcopenia, its prevalence in different blood cancers, interventions for sarcopenia, and future directions for the care of older adults with blood cancers who have sarcopenia.

Hematologic malignancies, including leukemias, lymphomas, and multiple myeloma, are diseases of older adults (age ≥ 60 years). Treatment decisions in older adults with cancer are heavily influenced by patient fitness: the ability of an individual patient to tolerate the off-target effects of anti-cancer therapy. Sarcopenia, defined as low muscle mass and strength, is increasingly recognized as an important marker of fitness. Furthermore, sarcopenia is known to be modifiable with nutrition and exercise interventions in older adults without cancer, but such evidence is limited for patients with cancer. Much of the literature on sarcopenia in older adults with cancer has focused on patients with solid tumors. However, there is an increasing body of literature on the impact of sarcopenia in older adults with hematologic malignancies. In this comprehensive review, we attempt to (i) describe the most up-to-date diagnostic criteria and diagnostic approach to sarcopenia, (ii) summarize the prognostic impact of sarcopenia among older adults with hematologic malignancies, (iii) discuss the proposed mechanisms of sarcopenia and its pathogenesis, (iv) review the evidence for interventions targeting sarcopenia, and (v) provide future directions for the advancement of sarcopenia management among older adults with hematologic malignancies.