Impact of pretransplant body mass index on the clinical outcome after allogeneic hematopoietic SCT

Abstract

To elucidate the impact of pretransplant body mass index (BMI) on the clinical outcome, we performed a retrospective study with registry data including a total of 12 050 patients (age ⩾ 18 years) who received allogeneic hematopoietic SCT (HSCT) between 2000 and 2010. Patients were stratified as follows: BMIo 18.5 kg/m 2 , Underweight, n = 1791; 18.5 ⩽ BMIo 25, Normal, n = 8444; 25 ⩽ BMIo 30, Overweight, n = 1591; BMI ⩾ 30, Obese, n = 224. The median age was 45 years (range, 18-77). A multivariate analysis showed that the risk of relapse was significantly higher in the underweight group and lower in the overweight and obese groups compared with the normal group (hazard ratio (HR), 1.16, 0.86, and 0.74, respectively). The risk of GVHD was significantly higher in the overweight group compared with the normal group. The risk of non-relapse mortality (NRM) was significantly higher in the overweight and obese group compared with the normal group (HR 1.19 and HR 1.43, respectively). The probability of OS was lower in the underweight group compared with the normal group (HR 1.10, P = 0.018). In conclusion, pretransplant BMI affected the risk of relapse and NRM after allogeneic HSCT. Underweight was a risk factor for poor OS because of an increased risk of relapse. Obesity was a risk factor for NRM.

Obesity-Associated Adipose Tissue Inflammation and Transplantation

“…Interestingly, only the overweight group, not the obese group, had increased acute GVHD, including class II-IV gut and liver GVHD (41). The authors postulated that the exposure of donor immune cells to the proinflammatory immune environment in obese patients altered functional status of the donor immune cells, increasing the risk of GVHD-related death (41). A recent meta-analysis that combined the results of eight different studies confirmed that obese HSCT recipient have increased risk of acute GVHD and postulates that they may also have increased mortality rates (42).…”

“…A study of more than 12,000 patients determined that obesity was not linked to a decrease in overall survival compared with normal BMI patients (41); however, in overweight and obese groups, the risk of nonrelapse mortality due to graft-versus-host disease (GVHD) or infection was higher than that in normal BMI groups (41). Interestingly, only the overweight group, not the obese group, had increased acute GVHD, including class II-IV gut and liver GVHD (41).…”

“…A study of more than 12,000 patients determined that obesity was not linked to a decrease in overall survival compared with normal BMI patients (41); however, in overweight and obese groups, the risk of nonrelapse mortality due to graft-versus-host disease (GVHD) or infection was higher than that in normal BMI groups (41). Interestingly, only the overweight group, not the obese group, had increased acute GVHD, including class II-IV gut and liver GVHD (41). The authors postulated that the exposure of donor immune cells to the proinflammatory immune environment in obese patients altered functional status of the donor immune cells, increasing the risk of GVHD-related death (41).…”

Severe weight loss in 3 months after allogeneic hematopoietic SCT was associated with an increased risk of subsequent non-relapse mortality

“…6 Even though oral caloric intake often recovers spontaneously, time taken for recovery is usually long and patients often experience significant weight loss. 7,8 Even though several studies assessed the impact of body mass index (BMI) before allogeneic HSCT, [9][10][11] there are limited data about the nutritional status of outpatients after allogeneic HSCT because the practice of screening of nutritional status is still rarely performed. Nutritional screening aims to identify patients who are malnourished or at risk of malnutrition.…”

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

“…Obesity was found in adults undergoing allo-HCT to reduce OS, increase NRM and the risk of infections. 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.…”