Impact of being overweight on outcomes of hematopoietic SCT: a meta-analysis

Abstract

The impact of being overweight on outcome after hematopoietic SCT (HSCT) is controversial. We performed meta-analyses to evaluate the impact of being overweight on acute graft-versus-host disease (aGVHD) risk and survival. Original data were obtained from MEDLINE, and studies that evaluated being overweight before transplantation in recipients as a risk factor for aGVHD or a prognostic factor for overall survival (OS) were extracted. Study-specific relative risks on the log scale comparing overweight with non-overweight patients were used to obtain a pooled RR with 95% confidence interval (CI). We identified 8 studies of aGVHD and 21 of OS. In allogeneic HSCT, the meta-analysis determined statistically significant associations of overweight recipients with aGVHD risk and OS. Meta-analysis of the 8 studies of aGVHD indicated that the RR for overweight to non-overweight patients was 1.186 (95% CI: 1.072-1.312). Regarding OS, meta-analysis of 11 allogeneic HSCT studies indicated that the RR for overweight to nonoverweight patients was 1.163 (1.009-1.340). Our results indicate that being overweight before transplantation in recipients is associated with a high aGVHD rate and worse survival after allogeneic HSCT. Potential heterogeneity especially in adult/pediatric patients limits the interpretability of our finding. Further, well-designed large cohort studies are warranted.

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

“…Obesity is also included as one of the comorbidities, and a score is assigned based on BMI > 35 kg/m 2 in adults or BMI for age of the 95 th percentile or higher in children. While the role of obesity as an independent risk factor on allogeneic transplant outcomes, such as GVHD, relapse, non-relapse mortality (NRM), and overall survival, has been previously explored by several groups, inconsistencies have been reported depending on the study population (12-24). Recently, plasma biomarkers predictive of GVHD and NRM have been identified (25-27).…”

Systematic Nutritional Support in Allogeneic Hematopoietic Stem Cell Transplant Recipients

“…Therefore, we expect that more candidates of HSCT will have these nutritional problems, which may increase the risk of morbidity and mortality after HSCT. In terms of body weight, several retrospective studies have shown the impact of pretransplantation body mass index (BMI) on the clinical outcome after allogeneic HSCT [8][9][10][11][12][13][14][15][16]. The results varied, but there is a clear trend of high BMI being associated with an increased risk of graft-versushost disease (GVHD) and nonrelapse mortality (NRM) and low BMI being associated with inferior overall survival because of an increased risk of relapse and NRM.…”

The impact of pre-transplant body weight on short- and long-term outcomes after allogeneic hematopoietic cell transplantation in adults using different weight classification tools

“…Overweight patients had the highest NRM but no inferior OS than normal-weight patients. Were the meta-analysis by Nakao et al, 13 the present study data and those from Fuji et al 14 pooled today, overweight would very likely no longer be associated with worse survival. However, Fuji et al 14 did identify underweight as a prognostic factor for poor OS because of an increased risk of relapse.…”

“…13 The overweight group was protected from relapse. However, this benefit was offset by excessive NRM, leading to this study's major finding, namely that overweight demonstrate no difference in impact on OS compared with normal-weight patients.…”

“…2,6,10,11,14 However, other studies detected no association between obesity and OS. 1,2,[4][5][6][7]9 A recent metaanalysis by Nakao et al 13 focused on the overweight impact on HCT outcomes. By pooling pediatric and adult allo-HCT studies, overweight at transplantation was associated with worse OS and a higher aGvHD rate.…”