Allogeneic transplant outcomes are not affected by body mass index (BMI) in patients with haematological malignancies

Obesity continues to be an increasing global health issue contributing to the complexity of chemotherapy dosing in the field of SCT. Investigation into the optimal dosing weight used to calculate chemotherapy doses in obese patients undergoing SCT is limited and inconclusive. Our single-center, retrospective study compared safety and efficacy outcomes by body mass index (BMI) for 476 adult lymphoma patients who underwent auto-SCT with a myeloablative chemotherapeutic regimen of BU, CY and etoposide dosed using adjusted body weight. Three weight groups categorized based on BMI were defined: normal/underweight ⩽ 24.9 kg/m 2 , overweight 25-29.9 kg/m 2 and obese ⩾ 30 kg/m 2 . Severity of mucositis, incidence of secondary malignancy, incidence of bacteremia and median hospital length of stay did not differ among the groups. The median times to absolute neutrophil count and platelet recovery were 10 days (P = 0.75) and 14 days (P = 0.17), respectively. Obese patients had a lower 100-day mortality compared with other weight groups, although this did not translate into an OS benefit. OS and disease relapse were similar among the groups. Our study demonstrates that use of adjusted body weight to calculate chemotherapy doses does not negatively have an impact on outcomes in obese patients undergoing auto-SCT with BU, CY and etoposide.

Section: Discussionmentioning

confidence: 99%

Outcomes after autologous SCT in lymphoma patients grouped by weight

Lau

Weber

Earl

et al. 2015

“…5,6 Furthermore, under-and overweight patients are at an increased risk for complications, non-relapse mortality and overall survival after alloHCT. [7][8][9][10] To date, few studies have assessed nutritional status before alloHCT, and most of them only recorded body mass index (BMI) as a potential risk factor for survival. [7][8][9][10] Except for one report by Kyle et al 11 on the development of lean body mass, there were until now no longitudinal data on nutritional status and body composition in the early post-transplant period, although several reports showed that depletion of micronutrients, mainly vitamin D, is common before and after alloHCT.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] To date, few studies have assessed nutritional status before alloHCT, and most of them only recorded body mass index (BMI) as a potential risk factor for survival. [7][8][9][10] Except for one report by Kyle et al 11 on the development of lean body mass, there were until now no longitudinal data on nutritional status and body composition in the early post-transplant period, although several reports showed that depletion of micronutrients, mainly vitamin D, is common before and after alloHCT. [12][13][14] There are now many nutritional parameters available and validated for cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation

Urbain

Birlinger

Lambert

et al. 2012

There are few longitudinal data on nutritional status and body composition of patients undergoing allogeneic hematopoietic cell transplantation (alloHCT). We assessed nutritional status of 105 patients before alloHCT and its course during the early posttransplant period to day þ 30 and day þ 100 via weight history, body mass index (BMI) normalized for gender and age, Subjective Global Assessment, phase angle normalized for gender, age, and BMI, and fat-free and body fat masses. Furthermore, we present a multivariate regression model investigating the impact of factors on body weight. At admission, 23.8% reported significant weight losses (45%) in the previous 6 months, and we noted 31.5% with abnormal age-and sex-adjusted BMI values (p10th, X90th percentiles). BMI decreased significantly (Po0.0001) in both periods by 11% in total, meaning a weight loss of 8.6 ± 5.7 kg. Simultaneously, the patients experienced significant losses (Po0.0001) of both fat-free and body fat masses. Multivariate regression model revealed clinically relevant acute GVHD (parameter estimate 1.43; P ¼ 0.02) and moderate/severe anorexia (parameter estimate 1.07; P ¼ 0.058) as independent factors influencing early weight loss. In conclusion, our results show a significant deterioration in nutritional status during the early post-transplant period. Predominant alloHCT-associated complications such as anorexia and acute GVHD became evident as significant factors influencing nutritional status.

“…93 Third, with the increased use of umbilical cord blood transplantation, achieving an adequate stem cell dose for obese patients remains a challenge. 94 Although there are conflicting data surrounding the independent influence of obesity on allogeneic transplantation outcomes, [95][96][97] retrospective studies in this area are limited to some degree by selection bias and likely underestimate an adverse effect of obesity on outcomes. Overall, it is likely that obesity will limit the application of allogeneic transplant, should the use of this treatment modality become routine in patients with myeloma.…”

Section: Impact Of Obesity On Myeloma Treatment and Prognosismentioning

confidence: 99%

The skinny on obesity and plasma cell myeloma: a review of the literature

Carson

Bates

Tomasson

2014

Despite tremendous advances in treatments for myeloma in the past decade, the disease remains incurable in the majority of patients. Here, we review recent data demonstrating an association between obesity and increased risk of myeloma development. This may be due to the pro-inflammatory cytokine profile caused by obesity. Currently, there are no screening or prevention strategies for myeloma, but we propose that obesity-associated inflammatory pathways, or obesity itself, may be amenable to intervention, thereby preventing the transition from pre-malignancy to myeloma. In addition, we suggest that the morbidity, mortality and the significant costs associated with myeloma treatment could be reduced by addressing modifiable risk factors, and that research efforts should explore this novel hypothesis. INTRODUCTIONOver the past several decades, the prevalence of obesity has increased markedly in the United States. 1 Today, two-thirds of the adult population in the United States is overweight (defined as body mass index (BMI) = 25 kg/m 2 and o 30 kg/m 2 ) or obese (BMI 30 kg/m 2 ). 2 A BMI greater than 25 kg/m 2 is associated with increased all-cause mortality. 3,4 This increased risk exists even in the absence of typically-measured metabolic abnormalities, suggesting that there is no 'benign phenotype' for obesity. 5 A substantial number of these premature obesity-related deaths is due to cancer. 6,7 Although the common solid tumor malignancies have received much attention, data from case-control and prospectively followed cohort studies have also demonstrated a positive association between obesity and plasma cell myeloma incidence and death. 7,8