Prognostic Impact of Sarcopenia and Myosteatosis on Survival in Haematologic Malignancies: Systematic Review and Meta‐Analysis

ABSTRACT Background Sarcopenia, the progressive loss of skeletal muscle mass, and myosteatosis, the pathological fat infiltration into muscle tissue, are emerging prognostic factors in oncology. Both can be evaluated on computed tomography (CT). Despite advances in treating haematologic neoplasms, risk stratification remains challenging, and novel imaging biomarkers are needed. This systematic review and meta‐analysis investigated the prognostic impact of sarcopenia and myosteatosis on survival outcomes in patients with haematologic neoplasms. Methods The analysis was performed and reported in accordance with Cochrane and PRISMA guidelines. Literature searches were conducted in MEDLINE library, Cochrane, Web of Science and SCOPUS through January 2025. Eligible studies assessed sarcopenia or myosteatosis via CT in adult patients with non‐Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma (MM), or leukaemia, across different clinical settings. Primary outcomes were overall survival (OS); secondary outcomes included progression‐free survival (PFS), and disease‐free survival (DFS), reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Results Thirty‐four studies were included, comprising 5309 patients for sarcopenia (29 studies) and 2213 for myosteatosis (11 studies), with six studies assessing both conditions. The sample size‐weighted prevalence was 43.9% for sarcopenia (median 48.8%, range 10.0%–86.8%) and 41.9% for myosteatosis (median 42.6%, range 22.0%–73.7%). Among sarcopenia studies, 44.8% assessed patients undergoing chemotherapy‐immunotherapy, 24.1% in haematopoietic stem cell transplantation settings and 17.2% during chemotherapy. In NHL, sarcopenia was associated with reduced OS in multivariable analysis (HR 1.70, 95% CI 1.42–2.03, p < 0.001) and univariable analysis (HR 2.00, 95% CI 1.63–2.47, p < 0.001; I 2 = 26%). Sarcopenia was associated with decreased PFS in NHL (multivariable HR 1.63, 95% CI 1.38–1.92, p < 0.001; I 2 = 0%; univariable HR 1.76, 95% CI 1.52–2.04, p < 0.001; I 2 = 0%). Myosteatosis was linked to inferior OS in NHL in multivariable analysis (HR 2.36, 95% CI 1.72–3.23, p < 0.001; I 2 = 0%) and to reduced PFS (multivariable HR 1.62, 95% CI 1.25–2.10, p < 0.001; I 2 = 0%; univariable HR 2.03, 95% CI 1.59–2.61, p < 0.001; I 2 = 0%). Sarcopenia was associated with inferior OS in leukaemia (HR 1.82, 95% CI 1.39–2.36, p < 0.001) and worse PFS in leukaemia (HR 2.22, 95% CI 1.30–3.79, p = 0.004). Myosteatosis was linked to reduced OS in MM (HR 1.97, 95% CI 1.19–3.26, p = 0.008) and leukaemia (HR 2.67, 95% CI 1.74–4.09, p < 0.001). Conclusions CT‐based muscle assessment is independently associated with survival outcomes in selected haematologic neoplasms.