Baseline body mass index among children and adults undergoing allogeneic hematopoietic cell transplantation: clinical characteristics and outcomes

Abstract

Obesity is an important public health problem that may influence the outcomes of hematopoietic cell transplantation (HCT). We studied 898 children and adults receiving first-time allogeneic hematopoietic stem cell transplants between 2004 and 2012. Pre-transplant body mass index (BMI) was classified as underweight, normal weight, overweight, or obese using the WHO classification, or age-adjusted BMI percentiles for children. The study population was predominantly Caucasian, and the median age was 51 years (5 months – 73 years). The cumulative 3-year incidence of non-relapse mortality (NRM) in underweight, normal weight, overweight, and obese patients was 20%, 19%, 20%, and 33%, respectively. Major causes of NRM were acute and chronic graft-versus-host disease (GVHD). The corresponding incidence of relapse was 30%, 41%, 37%, and 30%, respectively. Three-year overall survival was 59%, 48%, 47%, and 43%, respectively. Multivariate analysis showed that obesity was associated with higher NRM (HR 1.43, p=0.04), and lower relapse (HR 0.65, p=0.002). Pre-transplant plasma levels of ST2 and TNFR1 biomarkers were significantly higher in obese compared with normal weight patients (p=0.04 and p=0.05, respectively). The increase in NRM observed in obese patients was partially offset by lower incidence of relapse with no difference in overall survival.

Changes in protein serum levels during stem cell transplantation

“…ST2 was also included in a biomarkers panel predictive for cGvHD development, GvHD severity and TRM [24]. Finally, pretransplant ST2 levels were reported being higher in obese patients as compared to normal weight patients [25]. Our result displayed that soluble ST2 levels increased from baseline to both aGvHD and cGvHD onset, but no differences were seen in terms of response to treatment.…”

Metabolic Syndrome after Hematopoietic Cell Transplantation: At the Intersection of Treatment Toxicity and Immune Dysfunction

“…Pretransplantation plasma ST2 levels were higher in obese transplant recipients, as were subsequent nonrelapse mortality rates, most commonly from acute and chronic GVHD [52], indicating a possible connection between the inflammatory processes associated with obesity/MetSyn and GVHD.…”

The pro-inflammatory marker soluble suppression of tumorigenicity-2 (ST2) is reduced especially in diabetic morbidly obese patients undergoing bariatric surgery

“…Zeyda et al found elevated ST2 and IL-33 expression in omental and subcutaneous adipose tissue as well as increased plasma sST2 in severely obese subjects as compared to lean controls [9]. Gleimer et al also revealed higher sST2 in obese patients than in normal weight patients among children and adults undergoing hematopoietic cell transplantation [38]. However, the dynamic of circulating sST2 as well as its correlation with clinical and laboratory parameters before and after bariatric surgery was not studied before.…”