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The aim of the present study was to investigate predictors of WBC grade\u2009\u2265\u20093 (G3+) toxicity during chemoradiotherapy (CRT) of anal cancer.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Consecutive patients with locally advanced (T2\u2009\u2265\u20094\u00a0cm\u2014T4 or N+) anal cancer scheduled for two cycles of concomitant 5-fluorouracil and mitomycin C chemotherapy were selected from an institutional database (<jats:italic>n<\/jats:italic>\u2009=\u2009106). All received intensity modulated radiotherapy (IMRT; mean dose primary tumor 59.5\u00a0Gy; mean dose elective lymph nodes 45.1\u00a0Gy). Clinical data were extracted from medical records. The highest-grade WBC toxicity was recorded according to CTCAE version 5.0. Pelvic bone marrow (PBM) was retrospectively contoured and dose-volume histograms were generated. The planning CT was used to measure sarcopenia. Dosimetric, anthropometric, and clinical variables were tested for associations with WBC G3+ toxicity using the Mann\u2013Whitney test and logistic regression. Cox proportional hazard regression was used to assess predictors for overall survival (OS) and anal cancer specific survival (ACSS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>WBC G3+ was seen in 50.9% of the patients, and 38.7% were sarcopenic. None of the dosimetric parameters showed an association with WBC G3+ toxicity. The most significant predictor of WBC G3+ toxicity was sarcopenia (adjusted OR 4.0; <jats:italic>P<\/jats:italic>\u2009=\u20090.002). Sarcopenia was also associated with an inferior OS (adjusted HR 3.9; <jats:italic>P<\/jats:italic>\u2009=\u20090.01), but not ACSS (<jats:italic>P<\/jats:italic>\u2009=\u20090.07). Sensitivity analysis did not suggest that the inferior prognosis for sarcopenic patients was a consequence of reduced doses of chemotherapy or a prolonged radiation treatment time. Patients who experienced WBC G3+ toxicity had an inferior OS and ACSS, even after adjustment for sarcopenia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Sarcopenia was associated with increased risks of both WBC G3+ toxicity and death following CRT for locally advanced anal cancer. In this study, radiation dose to PBM was not associated with WBC G3+ toxicity. However, PBM was not used as an organ at risk for radiotherapy planning purposes and doses to PBM were high, which may have obscured any dose\u2013response relationships.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13014-021-01876-5","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T09:04:23Z","timestamp":1629104663000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Sarcopenia and dosimetric parameters in relation to treatment-related leukopenia and survival in anal cancer"],"prefix":"10.1186","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7419-6750","authenticated-orcid":false,"given":"Martin P.","family":"Nilsson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Johnsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Scherman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"issue":"16","key":"1876_CR1","doi-asserted-by":"publisher","first-page":"1914","DOI":"10.1001\/jama.299.16.1914","volume":"299","author":"JA Ajani","year":"2008","unstructured":"Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB 3rd, Thomas CR Jr, Mayer RJ, Haddock MG, Rich TA, Willett C. 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