1
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Gjærde LK, Ruutu T, Peczynski C, Boreland W, Kröger N, Blaise D, Schroeder T, Peffault de Latour R, Gedde-Dahl T, Kulagin A, Sengeløv H, Yakoub-Agha I, Finke J, Eder M, Basak G, Moiseev I, Schoemans H, Koenecke C, Penack O, Perić Z. The impact of pre-transplantation diabetes and obesity on acute graft-versus-host disease, relapse and death after allogeneic hematopoietic cell transplantation: a study from the EBMT Transplant Complications Working Party. Bone Marrow Transplant 2024; 59:255-263. [PMID: 38062242 PMCID: PMC10849948 DOI: 10.1038/s41409-023-02154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 02/09/2024]
Abstract
Obesity and diabetes can modulate immune responses, which may impact allogeneic HCT outcomes and GvHD. From the EBMT registry, we included 36,539 adult patients who underwent allogeneic HCT for a hematological malignancy between 2016 and 2020. Of these, 5228 (14%) had obesity (BMI ≥ 30 kg/m2), 1415 (4%) had diabetes (requiring treatment with insulin or oral hypoglycemics), and 688 (2%) had obesity + diabetes pre-transplantation. Compared with patients without diabetes or obesity, the hazard ratio (HR) of grade II-IV acute GvHD was 1.00 (95% confidence interval [CI] 0.94-1.06, p = 0.89) for patients with obesity, 0.95 (CI 0.85-1.07, p = 0.43) for patients with diabetes, and 0.96 (CI 0.82-1.13, p = 0.63) for patients with obesity + diabetes. Non-relapse mortality was higher in patients with obesity (HR 1.08, CI 1.00-1.17, p = 0.047), diabetes (HR 1.40, CI 1.24-1.57, p < 0.001), and obesity + diabetes (HR 1.38, CI 1.16-1.64, p < 0.001). Overall survival after grade II-IV acute GvHD was lower in patients with diabetes (HR 1.46, CI 1.25-1.70, p < 0.001). Pre-transplantation diabetes and obesity did not influence the risk of developing acute GvHD, but pre-transplantation diabetes was associated with poorer survival after acute GvHD.
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Affiliation(s)
- Lars Klingen Gjærde
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Tapani Ruutu
- Clinical Research Institute, Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | | | | | | | - Aleksandr Kulagin
- First State Pavlov Medical University of St. Petersburg, St., Petersburg, Russia
| | - Henrik Sengeløv
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Grzegorz Basak
- University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
| | - Ivan Moiseev
- First State Pavlov Medical University of St. Petersburg, St., Petersburg, Russia
| | | | | | - Olaf Penack
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Zinaida Perić
- University of Zagreb, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
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2
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Abou-Ismail MY, Fraser R, Allbee-Johnson M, Metheny L, Ravi G, Ahn KW, Bhatt NS, Lazarus HM, de Lima M, El Jurdy N, Hematti P, Beitinjaneh AM, Nishihori T, Badawy SM, Sharma A, Pasquini MC, Savani BN, Sorror ML, Stadtmauer EA, Chhabra S. Does recipient body mass index inform donor selection for allogeneic haematopoietic cell transplantation? Br J Haematol 2022; 197:326-338. [PMID: 35286719 PMCID: PMC9675037 DOI: 10.1111/bjh.18108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 01/22/2023]
Abstract
It is not known whether obesity has a differential effect on allogeneic haematopoietic cell transplantation outcomes with alternative donor types. We report the results of a retrospective registry study examining the effect of obesity [body mass index (BMI) > 30] on outcomes with alternative donors (haploidentical related donor with two or more mismatches and receiving post-transplant cyclophosphamide [haplo] and cord blood (CBU)] versus matched unrelated donor (MUD). Adult patients receiving haematopoietic cell transplantation for haematologic malignancy (2013-2017) (N = 16 182) using MUD (n = 11 801), haplo (n = 2894) and CBU (n = 1487) were included. The primary outcome was non-relapse mortality (NRM). The analysis demonstrated a significant, non-linear interaction between pretransplant BMI and the three donor groups for NRM: NRM risk was significantly higher with CBU compared to haplo at BMI 25-30 [hazard ratio (HR) 1.66-1.71, p < 0.05] and MUD transplants at a BMI of 25-45 (HR, 1.61-3.47, p < 0.05). The results demonstrated that NRM and survival outcomes are worse in overweight and obese transplant recipients (BMI ≥ 25) with one alternative donor type over MUD, although obesity does not appear to confer a uniform differential mortality risk with one donor type over the other. BMI may serve as a criterion for selecting a donor among the three (MUD, haplo and CBU) options, if matched sibling donor is not available.
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Affiliation(s)
- Mouhamed Yazan Abou-Ismail
- Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mariam Allbee-Johnson
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leland Metheny
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Gayathri Ravi
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kwang Woo Ahn
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Marcos de Lima
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Najla El Jurdy
- The Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Amer M Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, FL, USA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Marcelo C Pasquini
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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3
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Dang BN, Wilhalme H, Ch'ng J, De Oliveira S, Bowles L, Moore TB. Pediatric hematopoietic cell transplantation: Longitudinal trends in body mass index and outcomes. Pediatr Transplant 2020; 24:e13844. [PMID: 32997423 DOI: 10.1111/petr.13844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 01/23/2023]
Abstract
Pediatric recipients of HCT may have a high susceptibility for overweight and obesity, and obesity may negatively impact post-transplant mortality and survival. This is a single-center retrospective analysis of 297 pediatric patients who received HCT between 2005 and 2018. Patients were classified as UW, NW, OW, or OB based on age-adjusted BMI. A mixed-effects linear regression model controlling for patient, disease, and transplant-related characteristics was used to trend weight longitudinally. Comparisons were made between weight category and post-transplant outcomes. In the pretransplant period, 5.4%, 54.5%, 22.2%, and 17.8% of patients were UW, NW, OW, and OB, respectively. Five years post-transplantation, those numbers were 10.6%, 48.2%, 16.5%, and 24.7%. Overall, BMI increased 0.00094 ± 0.0001 kg/m2 each day post-transplant (P < .001), with older individuals demonstrating greater rates of increase. Further, there was a larger BMI increase in patients without TBI compared with those who received TBI (1.29 ± 0.49, P = .008). Rates of acute GVHD, chronic GVHD, and viral infections, in addition to time to platelet and neutrophil engraftment and 5-year survival estimates, were not significantly different based on pretransplant BMI. Overweight and obese individuals had poorer 5-year survival based on 100-day post-transplant BMI (P = .02). Overall, pediatric HCT recipients are at risk of developing obesity, which is associated with decreased survival. Adolescents and young adults demonstrate the highest risk of weight gain, representing a vulnerable population that requires close monitoring, additional interventions, and further research.
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Affiliation(s)
- Brian Norman Dang
- Division of Pediatric Hematology and Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Holly Wilhalme
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, USA
| | - James Ch'ng
- Division of Pediatric Hematology and Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Satiro De Oliveira
- Division of Pediatric Hematology and Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - LaVette Bowles
- Division of Pediatric Hematology and Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Theodore Bruce Moore
- Division of Pediatric Hematology and Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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4
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Gergis U, Reich-Slotky R, Abdulahad B. Gastric bypass bariatric surgery in patients undergoing allogeneic hematopoietic stem cell transplantation warrants special considerations. Bone Marrow Transplant 2020; 55:2202-2203. [PMID: 32371902 DOI: 10.1038/s41409-020-0922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/06/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Usama Gergis
- Thomas Jefferson University, Philadelphia, PA, USA.
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5
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Barban JB, Simões BP, Moraes BDGDC, da Anunciação CR, da Rocha CS, Pintor DCQ, Guerra DC, Silva DA, Brandão EDCM, Kerbauy F, Pires FRDO, Morais GL, Schmidt J, Sicchieri JMF, Barroso KSN, Viana LV, da Rocha MHM, Guimarães MP, Lazzari NLC, Hamerschlak N, Ramos PP, Gomes PN, Mendonça PDS, de Oliveira RC, Scomparim RC, Chiattone R, Diez-Garcia RW, Cardenas TDC, Miola TM, Costa TCDM, Rocha V, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults. EINSTEIN-SAO PAULO 2020; 18:AE4530. [PMID: 32049129 PMCID: PMC6999189 DOI: 10.31744/einstein_journal/2020ae4530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.
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Affiliation(s)
- Juliana Bernardo Barban
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazil Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Belinda Pinto Simões
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Bruna Del Guerra de Carvalho Moraes
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Daniela Cristina Querino Pintor
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daiane Cristina Guerra
- Centro de Transplante de Medula ÓsseaInstituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazil Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | | | - Edith de Castro Martins Brandão
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Fábio Kerbauy
- Universidade Federal de São PauloSão PauloSPBrazil Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Jayr Schmidt
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Juliana Maria Faccioli Sicchieri
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Karine Sampaio Nunes Barroso
- Universidade Federal do CearáHospital Universitário Walter CantídioFortalezaCEBrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
| | - Luciana Verçoza Viana
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrazilHospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Mariana Hollanda Martins da Rocha
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Nelson Hamerschlak
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Plinio Patricia Ramos
- Hospital Leforte LiberdadeSão PauloSPBrazil Hospital Leforte Liberdade, São Paulo, SP, Brazil.
| | - Plinio Nascimento Gomes
- Centro de Transplante de Medula ÓsseaInstituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazil Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | - Priscila da Silva Mendonça
- Universidade Federal do CearáHospital Universitário Walter CantídioFortalezaCEBrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
| | | | - Renata Corrêa Scomparim
- Universidade Estadual de CampinasCampinasSPBrazilUniversidade Estadual de Campinas, Campinas, SP, Brazil.
| | - Ricardo Chiattone
- Hospital SamaritanoSão PauloSPBrazilHospital Samaritano, São Paulo, SP, Brazil.
| | - Rosa Wanda Diez-Garcia
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Thais Manfrinato Miola
- A.C.Camargo Cancer CenterSão PauloSPBrazil A.C.Camargo Cancer Center, São Paulo, SP, Brazil.
| | - Thalita Cristina de Mello Costa
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Vanderson Rocha
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Andrea Z Pereira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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6
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Hirose EY, de Molla VC, Gonçalves MV, Pereira AD, Szor RS, da Fonseca ARBM, Fatobene G, Serpa MG, Xavier EM, Tucunduva L, Rocha V, Novis Y, Arrais-Rodrigues C. The impact of pretransplant malnutrition on allogeneic hematopoietic stem cell transplantation outcomes. Clin Nutr ESPEN 2019; 33:213-219. [PMID: 31451264 DOI: 10.1016/j.clnesp.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Malnutrition is a common finding in allogeneic hematopoietic stem cell transplantation (alloHSCT) patients, and there is some evidence that malnutrition might negatively affect the transplant outcomes. METHOD We performed a retrospective study with 148 patients aged 18-75 years, who underwent alloHSCT between 2011 and 2017. Patients were classified according to the body mass index (BMI) and the Subjective Global Assessment (SGA). The SGA was assessed on the day of hospitalization for the transplant, and classifies patients into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished). RESULTS The SGA classified 49 (33%) patients as well-nourished, 54 (37%) as moderately malnourished, and 45 (30%) as severely malnourished. SGA-C was also associated with severe acute graft versus host disease (aGVHD) with a cumulative incidence (CI) of 31% vs. a CI of 14% for combined well-nourished or moderately malnourished group (SGA-A or -B, P = 0.017). In multivariate analysis, SGA-C compared to SGA-A or -B, remained as an independent risk factor for aGVHD (hazard ratio - HR 1.68, 95% confidence interval - 95% CI 1.02-2.74), and nonrelapse mortality (NRM - HR 3.63, 95% CI 1.76-7.46), worse progression free survival (HR 2.12, 95% CI 1.25-3.60), and worse overall survival (HR 3.27, 95% CI 1.90-5.64). CONCLUSION Malnutrition increases the risk of aGVHD and NRM and has a negative impact on survival.
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Affiliation(s)
- Erika Yuri Hirose
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius Campos de Molla
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil.
| | | | - André Domingues Pereira
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ana Rita Brito Medeiro da Fonseca
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Vanderson Rocha
- Hospital Sírio Libanês, São Paulo, Brazil; Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo/ICESP, São Paulo, Brazil; Churchill Hospital, NHS-BT, Oxford, United Kingdom
| | - Yana Novis
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Celso Arrais-Rodrigues
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
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7
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Jabbour J, Manana B, Zahreddine A, Saade C, Charafeddine M, Bazarbachi A, Blaise D, El-Cheikh J. Sarcopenic obesity derived from PET/CT predicts mortality in lymphoma patients undergoing hematopoietic stem cell transplantation. Curr Res Transl Med 2018; 67:93-99. [PMID: 30583985 DOI: 10.1016/j.retram.2018.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/07/2018] [Accepted: 12/15/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sarcopenic Obesity (SO) is associated with worse survival among chemotherapy recipients. Research on SO is scarce among lymphoma patients receiving Hematopoietic Stem Cell Transplantation (HSCT). AIM assess prevalence of SO pre-HSCT (T0) and 3 months post-HSCT (T1) in lymphoma patients and determine the power of SO at T0 and T1 in predicting survival. METHODS Consecutive patients (age ≥16 years) having B and T cell lymphoma who underwent SCT and who had PET/CT scan pre-SCT and 3 months post SCT were included in the study. A cross sectional image was analyzed at the level of the 3rd Lumber Vertebrae to assess body composition parameters. RESULTS 93 patients [mean age: 38 (range: 17-70 years), 52 (55.9%) males, 45 (48%) Hodgkin and 48 (52%) Non-Hodgkin lymphoma, 81 (87%) autologous and 12 (13%) allogeneic SCT)] met the inclusion criteria. From T0 to T1, Sarcopenia rates increased (27% at T0 to 38% at T1, p = 0.013), Visceral adiposity decreased (46% at T0 to 30% at T1, p = 0.03) and SO decreased (42% at T0 to 20% at T1, p < 0.01). Length of stay, overall survival and progression free survival were significantly better in patients without sarcopenic obesity at T1. Cox-regression revealed SO at T1 was a risk factor for mortality [Adjusted Hazards Ratio = 8.2 (95% Confidence Interval: 1.9-36.2)]. CONCLUSION Sarcopenic obesity, prevalent in 42% of patients pre-HSCT, decreased 3 months post HSCT as lymphoma patients lost skeletal muscle and visceral adipose tissues. SO at T1 was the most impactful risk factor for mortality.
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Affiliation(s)
- J Jabbour
- Department of Clinical Nutrition, American University of Beirut Medical Center, Beirut, Lebanon; Doctoral School of Life Sciences and Health, Aix Marseille Université, Marseille, France
| | - B Manana
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Zahreddine
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - C Saade
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Charafeddine
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - D Blaise
- Hematology Department, Transplantation Unit, Paoli Calmettes Institute, Marseille, France; Centre de Recherche sur le Cancer de Marseille (CRCM), Inserm U 1068, Marseille, France
| | - J El-Cheikh
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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8
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Ren G, Cai W, Wang L, Huang J, Yi S, Lu L, Wang J. Impact of body mass index at different transplantation stages on postoperative outcomes in patients with hematological malignancies: a meta-analysis. Bone Marrow Transplant 2018; 53:708-721. [DOI: 10.1038/s41409-018-0234-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
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9
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Turcotte LM, Wang T, Hemmer MT, Spellman SR, Arora M, Couriel D, Alousi A, Pidala J, Abdel-Azim H, Ahmed I, Beitinjaneh A, Buchbinder D, Byrne M, Callander N, Chao N, Choi SW, DeFilipp Z, Gadalla SM, Gale RP, Gergis U, Hashmi S, Hematti P, Holmberg L, Inamoto Y, Kamble RT, Lehmann L, MacMillan MA, McIver Z, Nishihori T, Norkin M, O'Brien T, Olsson RF, Reshef R, Saad A, Savani BN, Schouten HC, Seo S, Solh M, Verdonck L, Vij R, Wirk B, Yared J, Horowitz MM, Knight JM, Verneris MR. Donor body mass index does not predict graft versus host disease following hematopoietic cell transplantation. Bone Marrow Transplant 2018; 53:932-937. [PMID: 29382954 PMCID: PMC6041147 DOI: 10.1038/s41409-018-0100-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Lucie M Turcotte
- University of Minnesota Blood and Marrow Transplant Program, Minneapolis, MN, USA.
| | - Tao Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael T Hemmer
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Couriel
- Utah Blood and Marrow Transplant Program, Salt Lake City, UT, USA
| | - Amin Alousi
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Ibrahim Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | | | - David Buchbinder
- Division of Pediatrics Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natalie Callander
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Nelson Chao
- Division of Cell Therapy and Hematologica, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Shahinaz M Gadalla
- Division of Cancer Epidemiology & Genetics, NIH-NCI Clinical Genetics Branch, Rockville, MD, USA
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Leslie Lehmann
- Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA, USA
| | - Margaret A MacMillan
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Maxim Norkin
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL, USA
| | - Tracey O'Brien
- Blood & Marrow Transplant Program, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Sachiko Seo
- Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Leo Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Jean Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer M Knight
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI, USA
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10
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Nutritional status of allogeneic hematopoietic stem cell transplantation recipients: influencing risk factors and impact on survival. Support Care Cancer 2017; 25:3085-3093. [DOI: 10.1007/s00520-017-3716-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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11
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Espinoza M, Perelli J, Olmos R, Bertin P, Jara V, Ramírez P. Nutritional assessment as predictor of complications after hematopoietic stem cell transplantation. Rev Bras Hematol Hemoter 2015; 38:7-14. [PMID: 26969769 PMCID: PMC4786753 DOI: 10.1016/j.bjhh.2015.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/31/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Nutritional support is pivotal in patients submitted to hematopoietic stem cell transplantation. Nutritional status has been associated with time of engraftment and infection rates. In order to evaluate the association between nutritional parameters and clinical outcomes after transplantation a cohort of transplant patients was retrospectively evaluated. Methods All 50 patients transplanted between 2011 and 2014 were included. The nutritional status before transplantation, ten days after transplantation and before discharge was assessed including anthropometry, body mass index, albumin, prealbumin and total urinary nitrogen. Results The median follow-up time was 41 months and the median age of patients was 41 years. Thirty-two underwent allogeneic and 18 autologous transplants. Diagnoses included acute leukemias (n = 27), lymphoma (n = 7), multiple myeloma (n = 13), and aplastic anemia (n = 3). Thirty-seven patients developed mucositis (three Grade 1, 15 Grade 2, 18 Grade 3 and one Grade 4), and twenty-two allogeneic, and five autologous transplant patients required total parenteral nutrition. Albumin and total urinary nitrogen were associated with length of hospital stay and platelet and neutrophil engraftment. None of the nutritional parameters evaluated were associated with overall survival. Non-relapse mortality was 14% and overall survival was 79% at 41 months of follow-up. Conclusions After hematopoietic stem cell transplantation, high catabolism was associated with longer length of hospital stay, the need of total parenteral nutrition and platelet and neutrophil engraftment times. Nutritional parameters were not associated with overall survival.
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Affiliation(s)
- Marcela Espinoza
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Javiera Perelli
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Roberto Olmos
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Pablo Bertin
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Verónica Jara
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Pablo Ramírez
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile.
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12
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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. Bone Marrow Transplant 2015; 51:144-7. [DOI: 10.1038/bmt.2015.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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13
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Baseline body mass index among children and adults undergoing allogeneic hematopoietic cell transplantation: clinical characteristics and outcomes. Bone Marrow Transplant 2014; 50:402-10. [PMID: 25531283 DOI: 10.1038/bmt.2014.280] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/14/2014] [Accepted: 11/03/2014] [Indexed: 01/14/2023]
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 SCTs between 2004 and 2012. Pretransplant 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 nonrelapse 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 GVHD. The corresponding incidence of relapse was 30%, 41%, 37% and 30%, respectively. Three-year OS was 59%, 48%, 47% and 43%, respectively. Multivariate analysis showed that obesity was associated with higher NRM (hazard ratio (HR) 1.43, P=0.04) and lower relapse (HR 0.65, P=0.002). Pretransplant 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 a lower incidence of relapse with no difference in OS.
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14
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Shem-Tov N, Labopin M, Moukhtari L, Ciceri F, Esteve J, Giebel S, Gorin NC, Schmid C, Shimoni A, Nagler A, Mohty M. Chemotherapy dose adjustment for obese patients undergoing hematopoietic stem cell transplantation: a survey on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Oncologist 2014; 20:50-5. [PMID: 25480827 DOI: 10.1634/theoncologist.2014-0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Appropriate chemotherapy dosing for obese patients with malignant diseases is a significant challenge because limiting chemotherapy doses in these patients may negatively influence outcome. There is a paucity of information addressing high-dose chemotherapy in obese patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS The Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) designed an electronic survey to assess current practice of dose adjustment of chemotherapy in obese patients undergoing HSCT. RESULTS A total of 56 EBMT centers from 27 countries responded to the online survey. Overall, 45 centers declared that they routinely adjust chemotherapy doses for obese patients (80.5%), and only 11 (19.5%) declared they do not adjust dose. Among the former group, most used body mass index as the parameter for defining obesity (28 centers, 62%). The method for determining the weight for chemotherapy calculation was actual body weight (ABW) in 16 centers, ideal body weight (IBW) in 10 centers, IBW plus 25% of the difference between IBW and ABW in 16 centers, and other methods for the rest. Among centers that used dose adjustment, 44% also capped the dose at 2 m(2) for a chemotherapy dose based on body surface area (BSA), whereas 56% did not cap. Interestingly, most of the centers (9 of 11) that did not adjust dose for weight also did not cap the BSA at 2 m(2). CONCLUSION This EBMT survey revealed large diversity among transplant centers regarding dose-adjustment practice for high-dose conditioning chemotherapy. Our next step is to analyze outcomes of transplantation according to dose-adjustment practice and, subsequently, to formulate a methodology for future prospective studies.
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Affiliation(s)
- Noga Shem-Tov
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Myriam Labopin
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Leila Moukhtari
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Fabio Ciceri
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Jordi Esteve
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Sebastian Giebel
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Norbert-Claude Gorin
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Christopher Schmid
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Avichai Shimoni
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
| | - Mohamad Mohty
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany
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15
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Evolution of nutritional status in patients with autologous and allogeneic hematopoietic stem cell transplant. Support Care Cancer 2014; 23:1341-7. [DOI: 10.1007/s00520-014-2473-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/06/2014] [Indexed: 01/04/2023]
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16
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The skinny on obesity and plasma cell myeloma: a review of the literature. Bone Marrow Transplant 2014; 49:1009-15. [PMID: 24820216 DOI: 10.1038/bmt.2014.71] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 01/21/2023]
Abstract
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.
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17
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Bubalo J, Carpenter PA, Majhail N, Perales MA, Marks DI, Shaughnessy P, Pidala J, Leather HL, Wingard J, Savani BN. Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee. Biol Blood Marrow Transplant 2014; 20:600-16. [PMID: 24462742 DOI: 10.1016/j.bbmt.2014.01.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/21/2014] [Indexed: 01/15/2023]
Abstract
Hematopoietic stem cell transplantation (HCT) is a potentially life-saving therapy for patients with malignant and nonmalignant disease states. This article reviews the current published literature on the dosing of pharmacologic agents used for HCT preparative regimens with specific focus on the obese patient population. The review found that dose adjustments for obesity have, to date, been based empirically or extrapolated from published data in the nontransplantation patient population. As a result, the Committee determined that clear standards or dosing guidelines are unable to be made for the obese population because Level I and II evidence are unavailable at this time. Instead, the Committee provides a current published literature review to serve as a platform for conditioning agent dose selection in the setting of obesity. A necessary goal should be to encourage future prospective trials in this patient population because further information is needed to enhance our knowledge of the pharmacokinetics and pharmacodynamics of conditioning agents in the setting of obesity.
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Affiliation(s)
- Joseph Bubalo
- Department of Pharmacy Services, Oregon Health and Science University Hospital, Portland, Oregon.
| | | | - Navneet Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - David I Marks
- Bristol Bone Marrow Transplant Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Paul Shaughnessy
- Adult Bone Marrow Transplant, Texas Transplant Institute, San Antonio, Texas
| | - Joseph Pidala
- Division of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
| | - Helen L Leather
- Division of Hematology/Oncology, University of Florida Health Cancer Center, Gainesville, Florida
| | - John Wingard
- Division of Hematology/Oncology, University of Florida Health Cancer Center, Gainesville, Florida
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
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18
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Altaf S, Enders F, Jeavons E, Krailo M, Barkauskas DA, Meyers P, Arndt C. High-BMI at diagnosis is associated with inferior survival in patients with osteosarcoma: a report from the Children's Oncology Group. Pediatr Blood Cancer 2013; 60:2042-6. [PMID: 23955975 DOI: 10.1002/pbc.24580] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/03/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Body mass index (BMI), at diagnosis has been associated with lower survival and increased toxicity in cancer patients. We analyzed the effect of BMI at diagnosis on therapy related toxicities and outcome in pediatric osteosarcoma patients treated on Children's Oncology Group (COG) trial INT0133. PROCEDURES All patients enrolled on COG-INT0133 with height, weight and toxicity information were eligible. BMI was expressed as age and gender specific percentiles using height and weight at diagnosis. Patients were classified into high, normal and low BMI groups. Logistic regression models were used to analyze toxicities; Kaplan-Meier curves were created to assess event free (EFS) and overall survival (OAS). RESULTS Seven hundred and ten patients met eligibility criteria. BMI distribution was: 447 normal BMI, 74 low BMI, and 189 high BMI. Renal toxicity was higher in the high BMI group (OR = 2.7, 95% CI 1.2-6.4, P = = 0.01) only during one of the courses of therapy. Compared to the normal BMI group, patients with high BMI had significantly worse OAS at 5 years compared to those with normal BMI, 69.7% versus 80.5% (HR = 1.6, 95% CI 1.1-2.2, P = 0.005) and a trend towards worse event-free survival at 3 years 66.2% versus 75.5% (HR = 1.3 95% CI 0.9-1.8, P = 0.05). There was no difference in EFS or OAS in patients with low BMI compared to patients with normal BMI. CONCLUSIONS High BMI at diagnosis is associated with worse OAS in patients with osteosarcoma. No clinically significant differences in toxicity were observed in the various BMI groups.
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19
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Impact of being overweight on outcomes of hematopoietic SCT: a meta-analysis. Bone Marrow Transplant 2013; 49:66-72. [DOI: 10.1038/bmt.2013.128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 07/08/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022]
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20
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21
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Relationship of Body Mass Index and Arm Anthropometry to Outcomes after Pediatric Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies. Biol Blood Marrow Transplant 2013; 19:1081-6. [DOI: 10.1016/j.bbmt.2013.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/18/2013] [Indexed: 11/23/2022]
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22
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Weiss BM, Vogl DT, Berger NA, Stadtmauer EA, Lazarus HM. Trimming the fat: obesity and hematopoietic cell transplantation. Bone Marrow Transplant 2012; 48:1152-60. [PMID: 23103679 DOI: 10.1038/bmt.2012.201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 12/28/2022]
Abstract
Obesity, increasing worldwide, is common in patients undergoing hematopoietic cell transplantation (HCT). This complex physiological state may alter the outcome of cancer therapies by many mechanisms including direct effects on pathogenesis, host responses to disease and altered pharmacology of chemotherapy. Obesity has been associated with multiple adverse health outcomes. Reports of obese patients undergoing HCT are challenging to interpret because of the heterogeneity of obesity definitions, underlying diseases, graft sources and chemotherapy regimens employed. Compared with normal-weight patients, it appears that obese patients undergoing allogeneic HCT have a higher risk of non-relapse mortality and inferior survival whereas those receiving autologous HCT appear to have equivalent outcomes. These findings are also difficult to interpret because there is no consistent standard for calculating chemotherapy dose in this group and future studies on specific regimens in this population are urgently needed. Patients who have undergone bariatric surgery may be at risk for unexpected events because of impaired nutritional state and altered pharmacokinetics of oral drugs. We recommend that future studies utilize more consistent and biologically relevant definitions of obesity and that the pharmacokinetics and pharmacodynamics of specific conditioning regimens be studied. Until more evidence is available, a rationale is presented for dosing based on adjusted body weight. Moreover, recommendations are provided to guide future research efforts based on more definitive measurements of body fat and its distribution available through modern quantitative imaging techniques using dual energy X-ray absorptiometry or magnetic resonance imaging scanning.
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Affiliation(s)
- B M Weiss
- Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine-2 West, Philadelphia, PA 19104, USA.
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Body mass index and bioelectrical impedance phase angle as potentially modifiable nutritional markers are independent risk factors for outcome in allogeneic hematopoietic cell transplantation. Ann Hematol 2012; 92:111-9. [DOI: 10.1007/s00277-012-1573-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/01/2012] [Indexed: 01/10/2023]
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24
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Urbain P, Birlinger J, Lambert C, Finke J, Bertz H, Biesalski HK. Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2012; 48:446-51. [DOI: 10.1038/bmt.2012.158] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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25
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White M, Murphy AJ, Hallahan A, Ware RS, Fraser C, Davies PSW. Survival in overweight and underweight children undergoing hematopoietic stem cell transplantation. Eur J Clin Nutr 2012; 66:1120-3. [DOI: 10.1038/ejcn.2012.109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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The role of body mass index and other body composition parameters in early post-transplant complications in patients undergoing allogeneic stem cell transplantation with busulfan–cyclophosphamide conditioning. Int J Hematol 2011; 95:95-101. [DOI: 10.1007/s12185-011-0980-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 11/22/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
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27
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Vogl DT, Wang T, Pérez WS, Stadtmauer EA, Heitjan DF, Lazarus HM, Kyle RA, Kamble R, Weisdorf D, Roy V, Gibson J, Ballen K, Holmberg L, Bashey A, McCarthy PL, Freytes C, Maharaj D, Maiolino A, Vesole D, Hari P. Effect of obesity on outcomes after autologous hematopoietic stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 2011; 17:1765-74. [PMID: 21624486 DOI: 10.1016/j.bbmt.2011.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/02/2011] [Indexed: 12/22/2022]
Abstract
Obesity has implications for chemotherapy dosing and selection of patients for therapy. Autologous hematopoietic stem cell transplant (AutoHCT) improves outcomes for patients with multiple myeloma, but optimal chemotherapy dosing for obese patients is poorly defined. We analyzed the outcomes of 1087 recipients of AutoHCT for myeloma reported to the CIBMTR between 1995 and 2003 who received high-dose melphalan conditioning, with or without total body irradiation (TBI). We categorized patients by body mass index (BMI) as normal, overweight, obese, or severely obese. There was no overall effect of BMI on progression-free survival (PFS), overall survival (OS), progression, or nonrelapse mortality (NRM). In patients receiving melphalan and TBI conditioning, obese and severely obese patients had superior PFS and OS compared with normal and overweight patients, but the clinical significance of this finding is unclear. More obese patients were more likely to receive a reduced dose of melphalan, but there was no evidence that melphalan or TBI dosing variability affected PFS. Therefore, current common strategies of dosing melphalan do not impair outcomes for obese patients, and obesity should not exclude patients from consideration of autologous transplantation. Further research is necessary to optimize dosing of both chemotherapy and radiation in obese patients.
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Affiliation(s)
- Dan T Vogl
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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28
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The effect of obesity on outcome of unrelated cord blood transplant in children with malignant diseases. Bone Marrow Transplant 2010; 46:1309-13. [DOI: 10.1038/bmt.2010.312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Deeg HJ, Sandmaier BM. Who is fit for allogeneic transplantation? Blood 2010; 116:4762-70. [PMID: 20702782 PMCID: PMC3253743 DOI: 10.1182/blood-2010-07-259358] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 08/07/2010] [Indexed: 11/20/2022] Open
Abstract
The use of allogeneic hematopoietic cell transplantation (HCT) has expanded progressively, facilitated by the increasing availability of unrelated donors and cord blood, and the inclusion of older patients as transplantation candidates. Indications remain diagnosis-dependent. As novel nontransplantation modalities have been developed concurrently, many patients come to HCT only when no longer responding to such therapy. However, patients with refractory or advanced disease frequently relapse after HCT, even with high-dose conditioning, and more so with reduced-intensity regimens as used for patients of older age or with comorbid conditions. Thus, patients with high-risk malignancies who have substantial comorbidities or are of advanced age are at high risk of both relapse and nonrelapse mortality and should probably not be transplanted. Being in remission or at least having shown responsiveness to pre-HCT therapy is generally associated with increased transplantation success. In addition, to handle the stress associated with HCT, patients need a good social support system and a secure financial net. They must be well informed, not only about the transplantation process, but also about expected or potential post-HCT events, including graft-versus-host disease and delayed effects that may become manifest only years after HCT.
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Affiliation(s)
- H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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30
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Barker CC, Agovi MA, Logan B, Lazarus HM, Ballen KK, Gupta V, Hale GA, Frangoul H, Ho V, Rizzo JD, Pasquini MC. Childhood obesity and outcomes after bone marrow transplantation for patients with severe aplastic anemia. Biol Blood Marrow Transplant 2010; 17:737-44. [PMID: 20817111 DOI: 10.1016/j.bbmt.2010.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 08/24/2010] [Indexed: 11/19/2022]
Abstract
The prevalence of obesity in the pediatric population has increased in the last 2 decades and represents a serious health concern, with potential impact on outcomes of hematopoietic cell transplantation (HCT). We studied the effect of weight by age-adjusted body mass index (BMI) percentile in 1,281 pediatric patients (age 2-19 years) with severe aplastic anemia who underwent HCT between 1990 and 2005. The study population was divided into 5 weight groups-underweight, risk of underweight, normal BMI range, risk of overweight, and overweight-according to age-adjusted BMI percentiles. Cox proportional hazards regression models for survival and acute graft-versus-host disease (aGVHD), performed using weight groups as the main effect and the normal BMI range (26th-75th percentile) as the baseline comparison, found higher mortality among overweight children (>95th percentile adjusted for age). Weight at transplantation did not increase the adjusted risk of grade III-IV aGVHD. The 1-year and 2-year overall survival rates were 60% and 59% for overweight children, compared with >70% in children with lower BMI at both time points (P < .001). Other significant factors associated with survival included race and region, donor type, conditioning regimens in related donor transplants, performance score, and year of transplantation. In conclusion, overweight children with aplastic anemia have worse outcomes after HCT. The impact of obesity on survival outcomes in children should be discussed during pretransplantation counseling.
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Affiliation(s)
- Collin C Barker
- British Colombia Children's Hospital, Vancouver, British Columbia, Canada
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31
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Allogeneic transplant outcomes are not affected by body mass index (BMI) in patients with haematological malignancies. Ann Hematol 2010; 89:1141-5. [DOI: 10.1007/s00277-010-1001-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
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32
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August DA, Huhmann MB. A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr 2009; 33:472-500. [PMID: 19713551 DOI: 10.1177/0148607109341804] [Citation(s) in RCA: 301] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- David Allen August
- Department of Surgery, Division of Surgical Oncology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
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33
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Bardin C. Quelle posologie de médicaments chez l’enfant obèse ? Arch Pediatr 2009; 16:965-7. [DOI: 10.1016/s0929-693x(09)74220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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34
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Sriharsha L, Lipton JH, Pond G, Ma C, Raybardhan S, Messner HA, Seki JT. Examining the safety and efficacy of a chemotherapy dosing method in Allogeneic Stem Cell Transplant patients of extreme body size. J Oncol Pharm Pract 2009; 15:201-10. [DOI: 10.1177/1078155208101960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. There is no consensus on a universal dosing method for calculating high-dose chemotherapy in allogeneic Stem Cell Transplant (SCT) patients. The Metropolitan Life (Met-Life) Insurance Company’s weight—height tables have been used to determine body weight for chemotherapy dosing for SCT, however no formal study has been done to determine if the Met-Life weight— height tables can be used for chemotherapy dosing in SCT. We retrospectively studied the use of Met-Life weight—height tables for chemotherapy dosing in SCT. Our goal is to determine if patients with extremes of body size who had undergone an SCT and were dosed according to the Met-Life weight— height tables had an increase of Treatment Related Morbidity (TRM) or mortality or relapse. Patients and Methods. Patients were grouped into three different treatment regimens, cyclophosphamide/TBI, busulphan/cyclophosphamide, and AraC/cyclophosphamide/TBI. Patients in each treatment regimen were further divided into five equal groups based on weight. Treatment related morbidity and mortality was evaluated by comparing the lowest and highest quintiles to the middle quintiles within each treatment regimen. Result. Data from 262 patients was evaluated in this study. Overall, there was not an increase in TRM or mortality or in relapse in patients with extremes of body size. Conclusion. The Met-Life weight—height tables could be used to dose patients undergoing allogeneic SCTs. Additional prospective studies would need to be done comparing other chemotherapy dosing methods with the Met-Life weight—height tables to further validate this conclusion.
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Affiliation(s)
- Lakshmi Sriharsha
- Departments of Pharmacy, University of Toronto, Princess Margaret Hospital, Ontario, Canada
| | - Jeffrey H Lipton
- Medical Oncology and Hematology, University of Toronto, Princess Margaret Hospital, Ontario, Canada
| | - Greg Pond
- Department of Biostatistics University of Toronto, Princess Margaret Hospital, Ontario, Canada
| | - Clement Ma
- Department of Biostatistics University of Toronto, Princess Margaret Hospital, Ontario, Canada
| | - Sumit Raybardhan
- Departments of Pharmacy, University of Toronto, Princess Margaret Hospital, Ontario, Canada
| | - Hans A Messner
- Medical Oncology and Hematology, University of Toronto, Princess Margaret Hospital, Ontario, Canada
| | - Jack T Seki
- Departments of Pharmacy, University of Toronto, Princess Margaret Hospital, Ontario, Canada,
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Fuji S, Kim SW, Yoshimura KI, Akiyama H, Okamoto SI, Sao H, Takita J, Kobayashi N, Mori SI. Possible association between obesity and posttransplantation complications including infectious diseases and acute graft-versus-host disease. Biol Blood Marrow Transplant 2009; 15:73-82. [PMID: 19135945 DOI: 10.1016/j.bbmt.2008.10.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
Abstract
Both obesity and malnutrition are considered risk factors for complications after bone marrow transplantation (BMT). To elucidate the impact of pretransplantation body mass index (BMI) on clinical outcome, we performed a retrospective cohort study with registration data from the Japan Marrow Donor Program (JMDP). Between January 1998 and December 2005, a total of 3935 patients received unrelated BMT through the JMDP; of these, 3827 patients for whom pretransplantation height and weight data were available were included in the study. Patients were stratified according to pretransplantation BMI values (low BMI: BMI < 18 kg/m(2), n = 295; normal BMI: 18 < or = BMI < 25 kg/m(2), n = 2906; overweight: 25 < or = BMI <30 kg/m(2), n = 565; obese: 30 kg/m(2) < or = BMI, n = 61). In a univariate analysis, pretransplantation BMI was associated with a significantly greater risk of grade II-IV acute graft-versus-host disease (GVHD; P = .03). Multivariate analysis showed that pretransplantation BMI tended to be associated with an increased risk of grade II-IV acute GVHD (P = .07). Obesity was associated with an increased risk of infection compared with normal BMI (odds ratio = 1.9; 95% confidence interval = 1.1 to 3.2; P = .02). Our findings demonstrate a correlation between pretransplantation BMI and posttransplantation complications. Although BMI depends strongly on multiple factors, the effect of obesity on clinical outcome should be evaluated in a prospective study.
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Affiliation(s)
- Shigeo Fuji
- Department of Hematology and Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
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36
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Fernandez CV, Anderson J, Breslow NE, Dome JS, Grundy P, Perlman EJ, Green DM. Anthropomorphic measurements and event-free survival in patients with favorable histology Wilms tumor: a report from the Children's Oncology Group. Pediatr Blood Cancer 2009; 52:254-8. [PMID: 18989885 PMCID: PMC2744809 DOI: 10.1002/pbc.21809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We retrospectively examined the effect of body weight and body mass index (BMI) on event-free survival (EFS) of children with Wilms tumor treated on National Wilms Tumor Study-5 (NWTS-5). PATIENTS AND METHODS Eligible study participants: stages I-IV favorable histology Wilms tumor with immediate nephrectomy; height and weight recorded at diagnosis, and loss of heterozygosity for chromosomes 1p and 16q assessed. RESULTS A total of 1,532 patients were included in the analysis. The median follow-up was 4.9 years. 493 patients were less than 2 years of age and 1039 were 2 years of age or older. In both age groups there were more patients than expected with a weight or body mass index (BMI) less than the 10 per thousand or greater than the 90 per thousand. There was no relationship of weight-for-age or BMI-for-age and EFS in univariate analyses (P = 0.28, log-rank test for both comparisons). A Cox proportional hazards model, stratified by risk/treatment groups, showed that, among patients less than 2 years of age, low or high weight-for-age was not predictive of EFS (P = 0.16). Similarly, a Cox proportional hazards model, stratified by risk/treatment groups, showed that among patients greater than 2 years of age, low or high body mass index for age was not predictive of EFS (P = 0.58). CONCLUSIONS There was no evidence that anthropomorphic data obtained at diagnosis for patients with favorable histology stages I-IV Wilms tumor was predictive for EFS in the setting of current treatment regimens. There were more patients with lower or higher weight/BMI than expected.
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Affiliation(s)
- Conrad V. Fernandez
- IWK Health Centre and Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James Anderson
- Children’s Oncology Group Data Center (Omaha) and the University of Nebraska Medical Center, Omaha, NE
| | | | - Jeffrey S. Dome
- Division of Oncology, Children’s National Medical Center, Washington, DC
| | - P.E. Grundy
- Department of Pediatrics, University of Alberta, Edmonton, Alta, Canada
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37
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Bulley S, Gassas A, Dupuis LL, Aplenc R, Beyene J, Greenberg ML, Doyle JJ, Sung L. Inferior outcomes for overweight children undergoing allogeneic stem cell transplantation. Br J Haematol 2007; 140:214-7. [PMID: 18028482 DOI: 10.1111/j.1365-2141.2007.06900.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This retrospective cohort study aimed at determining whether overweight children undergoing allogeneic stem cell transplantation (SCT) had inferior overall survival compared with children who were not overweight. Children >/=2 years of age who received allogeneic SCT were included. Overweight was defined as a body mass index >/= 95th percentile; 54/325 (17%) children were overweight. Overall survival at 5 years was significantly inferior at 46.6 +/- 7.3% in the overweight group compared with 59.5 +/- 3.2% in the non-overweight group (P = 0.02). Our study demonstrated that overweight children who undergo allogeneic SCT had inferior survival compared with children who were not overweight.
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Affiliation(s)
- Sean Bulley
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
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38
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Abstract
Today's obesity pandemic began in the United States, spread to Western Europe and other developed regions, and is emerging in developing countries. Its influences on outcomes of childhood cancer are unknown. A recent Children's Oncology Group symposium considered epidemiology of obesity, pharmacology of chemotherapy and outcomes in obese adults with cancer, excess mortality in obese pediatric patients with acute myeloid leukemia (AML), and complications in obese survivors. The salient points are summarized herein. Body mass index (BMI) is the accepted index of weight for height and age. In the US, obesity prevalence (BMI > 95th centile) is increasing in all pediatric age groups and accelerating fastest among black and Hispanic adolescents. Pharmacologic investigations are few and limited: half-life, volume of distribution, and clearance in obese patients vary between drugs. Obese adults with solid tumors generally experience less toxicity, suggesting underdosing. For patients undergoing bone marrow transplantation, obese adults generally experience greater toxicity. In pediatric acute myeloblastic leukemia, obese patients have greater treatment-related mortality (TRM), similar toxicity and relapse rates, and inferior survival compared with patients who are not obese. An excess of female survivors of childhood leukemia who received cranial irradiation are obese. Ongoing treatment effects of childhood cancer may predispose to a sedentary lifestyle. These findings call for measures to prevent obesity, retrospective and prospective studies of chemotherapy pharmacology of analyzed according to BMI and outcomes, additional studies of the obesity impact on outcomes in pediatric cancer, and promotion of a healthy lifestyle among survivors.
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Affiliation(s)
- Paul C Rogers
- Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
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39
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Auner HW, Zebisch A, Ofner P, Sill H, Linkesch W, Krause R. Evaluation of potential risk factors for early infectious complications after autologous peripheral blood stem cell transplantation in patients with lymphoproliferative diseases. Ann Hematol 2005; 84:532-7. [PMID: 15809882 DOI: 10.1007/s00277-005-1025-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 02/12/2005] [Indexed: 10/25/2022]
Abstract
A number of risk factors for the occurrence of neutropaenic fever after haematopoietic stem cell transplantation (HSCT) have been proposed. We were interested in whether these factors remain valid for several early infection-related outcomes when applied to a homogeneous group of patients in uni- and multivariate analyses. Therefore, we analysed 144 consecutive patients with lymphoproliferative disorders receiving autologous peripheral blood HSCT. Variables tested as potential risk factors for the occurrence of fever, documented infection (DI), microbiologically documented infection (MDI) or failure of first-line antimicrobial therapy were sex, conditioning regimen, prolonged neutropaenia, low number of CD34+ cells transplanted, purging, lack of selective gut decontamination, higher age and increased body mass index. In uni- and multivariate analyses, conditioning including total body irradiation was the only risk factor for the occurrence of fever, and neutropaenia >or=10 days was the only factor associated with failure of first-line antimicrobial therapy. None of the variables tested was associated with an increased risk for DI or MDI. This analysis suggests that a number of previously proposed risk factors actually are of minor clinical relevance for early infections in the majority of patients receiving autologous HSCT.
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Affiliation(s)
- H W Auner
- Division of Hematology, Medical University, Auenbruggerplatz, 8036, Graz, Austria.
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40
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Abstract
Obesity is a common and increasing problem affecting the developed world. Chemotherapy pharmacokinetics in the context of obesity demonstrate prolonged elimination time for several agents, but there is no consensus regarding optimal dosing schemes. Retrospective studies suggest differences in toxicity for obese adult patients but these data may be greatly impacted by chemotherapy dose adjustments. Outcome data from several studies have suggested that obese adult patients suffer poorer disease-free survival and overall survival, although this is not a uniform conclusion in all studies. Prospective studies of chemotherapy pharmacokinetics are needed to address the issue of optimal chemotherapy dosing in the obese population.
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Affiliation(s)
- W H Navarro
- Division of Hematology/Oncology, University of California, San Francisco, CA 94143-0324, USA
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41
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Rocha V, Labopin M, Gluckman E, Powles R, Arcese W, Bacigalupo A, Reiffers J, Iriondo A, Ringdén O, Ruutu T, Frassoni F. Relevance of bone marrow cell dose on allogeneic transplantation outcomes for patients with acute myeloid leukemia in first complete remission: results of a European survey. J Clin Oncol 2002; 20:4324-30. [PMID: 12409331 DOI: 10.1200/jco.2002.11.058] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many attempts have been made to improve the results of allogeneic bone marrow transplantation (alloBMT) for patients with acute myeloid leukemia (AML) in first complete remission (CR1). Bone marrow cell dose has been reported to be an important factor in alloBMT; however, its true impact on relapse incidence (RI), leukemia-free survival (LFS), and nonrelapse mortality (NRM) in a large cohort of patients is unknown. PATIENTS AND METHODS From January 1992 to December 1999, 572 bone marrow transplantation recipients reported to the European Blood and Marrow Transplantation (EBMT) registry underwent allografting from an HLA-identical sibling donor with an unmanipulated bone marrow for AML in CR1. RESULTS The median number of nucleated cells (NCs) infused was 2.6 x 10(8)/kg. Estimated 5-year NRM, LFS, and RI for patients receiving more or less than 2.6 x 10(8) NCs/kg were, respectively, 18% +/- 5% v 30% +/- 5% (P =.001), 68% +/- 3% v 46% +/- 3% (P <.00001), and 14% +/- 4% v 24% +/- 5% (P =.004). The association of cell dose with the above outcomes was confirmed in multivariate analyses for NRM (relative risk [RR], 0.53; P =.0007), for LFS (RR, 0.53; P =.00008), and for RI (RR, 0.57; P =.02). The cell dose was also an important factor for neutrophil (RR, 0.76; P =.009) and platelet (RR, 0.77; P =.03) recoveries; however, it did not statistically influence the incidence of acute graft-versus-host disease. CONCLUSION This study shows that marrow cell dose is one of the most important factors influencing relapse, NRM, and LFS after alloBMT for patients with AML in CR1. Therefore, increasing the marrow cell dose should substantially improve the survival of these patients.
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Affiliation(s)
- Vanderson Rocha
- Hematopoietic Stem Cell Transplant Unit, Hôpital Saint Louis, and Service d'Hématologie, CHU Saint-Antoine and European Data Management Office, Institut des Cordeliers, Paris, France.
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42
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Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002. [PMID: 11841046 DOI: 10.1177/0148607102026001011] [Citation(s) in RCA: 468] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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43
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Abstract
The authors review the psychosocial aspects of transplantation. They first review psychosocial risk factors that place transplant patients at higher risk for noncompliance and negative outcomes. They then discuss what assessments should be included in a pretransplantation psychosocial evaluation. Goals of the psychosocial evaluation include selection of candidates most likely to benefit from transplantation and identification of areas for psychosocial intervention, both before and after transplantation. The assessment should address the patient's premorbid psychiatric state, past adaptation to stressors, history of compliance with treatment, substance abuse history, and level of social support, including community and faith-based support systems. Results of psychometric assessments may be helpful when considered in conjunction with a clinical interview and other sources of information about the patient. It may also be helpful to use a screening tool developed specifically to evaluate psychosocial factors relevant to transplantation, such as the Psychological Assessment of Candidates for Transplantation (PACT) scale and the Transplantation Evaluation Rating Scale (TERS). The authors then review issues related to psychopharmacologic interventions in transplant patients, including the use of antidepressant medication pre- and post-transplant, strategies for avoiding delirium associated with immunosuppressive medications immediately post-transplantation, neuropsychiatric symptoms associated with interferon alpha therapy for hepatitis C, and interactions between over-the-counter and herbal agents (e.g., St. John's Wort) and immunosuppressive agents. Although limited research has been done on nonpharmacologic interventions, such as transplant support groups, it appears that certain types of group therapy, in particular, cognitive-behavioral groups that target specific risk factors such as depression, distress, and compliance, may also offer promising approaches for dealing with the problems of transplant patients. The authors then focus on two special situations that create particular problems for transplantation teams: liver transplantation in patients with alcoholic liver disease (ALD) and obesity in transplant patients. The authors conclude that the prognosis for patients with ALD who receive liver transplantation is similar to that of non-alcoholics and that alcoholism is not a contraindication for liver transplantation. However, careful preliminary psychosocial assessment is essential to review candidates for factors that are predictive of relapse, while close follow-up post-transplantation can help improve outcomes. It appears that obesity can increase the risk of negative outcomes in transplant patients, although there is currently no consensus on the use of obesity as an exclusion criteria. Interventions that take into account the special psychological and medical needs of transplant patients need to be developed for treating obesity both pre- and post-transplantation. Improved strategies for identifying high-risk patients and finding ways to intervene both pre- and post-transplantation can not only help lengthen transplant recipients' life spans, but also improve their adaptation to transplantation and lead to improved quality of life.
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Affiliation(s)
- S G Jowsey
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
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44
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Ritchie DS, Wirth A, Grigg AP. Successful transplant outcome in a morbidly obese patient with acute myeloblastic leukemia. Leuk Lymphoma 2001; 42:1111-4. [PMID: 11697629 DOI: 10.3109/10428190109097732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a case of matched unrelated bone marrow transplant (BMT) in a morbidly obese patient with acute myeloblastic leukaemia. The challenges presented in the management of this case included the calculation of chemotherapy and radiotherapy doses and the acute presentation of obstructive sleep apnea. Despite these difficulties, an ultimately successful outcome was obtained, indicating that although associated with increased risk of peri-transplant morbidity, obesity need not represent a contraindication to BMT.
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Affiliation(s)
- D S Ritchie
- Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Australia
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45
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Meloni G, Proia A, Capria S, Romano A, Trapé G, Trisolini SM, Vignetti M, Mandelli F. Obesity and autologous stem cell transplantation in acute myeloid leukemia. Bone Marrow Transplant 2001; 28:365-7. [PMID: 11571508 DOI: 10.1038/sj.bmt.1703145] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2001] [Accepted: 05/11/2001] [Indexed: 11/09/2022]
Abstract
In the bone marrow transplant setting, several authors hypothesized that severely overweight patients are at increased risk of transplant-related toxicity, but different definitions of obesity, different body weight groupings and heterogeneous samples of patients were analyzed. To overcome these limitations, we retrospectively considered a homogeneous group of 54 patients (median age 36.5 years), with a diagnosis of de novo acute myeloid leukemia (AML), autografted in first complete remission (CR) with the Bu-Cy2 conditioning regimen, dosed on actual body weight. Patients were classified into three groups (obese, non-obese, underweight) using body mass index (BMI = kg/m(2)); for each group we analyzed transplant-related toxicity and mortality, overall survival and disease-free survival (OS/DFS). In spite of the relatively small number of patients, in our results high BMI appears a predictive factor for an increase of treatment-related toxicity and mortality. Moreover, 30 (55%) patients are currently alive in continuous CR, and after a median follow-up of 76.5 months (range 14-137) statistically significant differences in OS and DFS were detected between obese and non-obese groups (P = 0.012 and 0.021, respectively). Our study suggests that obesity may represent an independent risk factor for autograft in AML and further investigations are warranted.
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Affiliation(s)
- G Meloni
- Department of Biotecnologie Cellulari ed Ematologia, University La Sapienza, Roma, Italy
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Lenssen P, Bruemmer B, Aker SN, McDonald GB. Nutrient support in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr 2001; 25:219-28. [PMID: 11434654 DOI: 10.1177/0148607101025004219] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High-dose cytoreduction and hematopoietic stem cell infusion form the basis for treatment of hematologic cancers, defects or failure of hematopoiesis, and some solid tumors. As an antitumor therapy, allogeneic hematopoietic cell transplantation (HCT) is superior to autologous HCT by induction of a graft-vs-tumor effect. However, recipients of allografts suffer higher transplant-related mortality owing to graft-vs-host disease (GVHD). Nutrition support research must recognize that HCT is a heterogeneous modality whose short and long-term outcomes are affected by transplant type, preparative regimens, diagnosis, disease stage, age, and nutritional status. The field of HCT will diversify further as lower dose cytoreduction and mixed chimerism grafts allow expansion of the technique to older patients and to other diseases.
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Affiliation(s)
- P Lenssen
- Clinical Nutrition, Children's Hospital and Regional Medical Center, Seattle, Washington 98105-0371, USA.
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Tarella C, Caracciolo D, Gavarotti P, Argentino C, Zallio F, Corradini P, Novero D, Magnani C, Pileri A. Overweight as an adverse prognostic factor for non-Hodgkin's lymphoma patients receiving high-dose chemotherapy and autograft. Bone Marrow Transplant 2000; 26:1185-91. [PMID: 11149729 DOI: 10.1038/sj.bmt.1702692] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite detailed evaluation of disease-associated prognostic factors, little is known about the impact of overweight in autograft programs for non-Hodgkin's lymphoma (NHL) patients. In order to address this issue, 121 NHL patients were retrospectively evaluated. They had been upfront (92 patients) or in relapse (29 patients) and received high-dose sequential (HDS) chemotherapy including peripheral blood progenitor cell (PBPC) autograft. Body mass index (BMI) was calculated as weight in kilograms divided by the square of the height in meters; overweight was defined as BMI > or = 28. Univariate and multivariate analyses were used to determine the prognostic implication of overweight and other known prognostic indicators on overall (OS) and event-free (EFS) survival for the entire group and overweight and non-overweight (reference) subgroups. With a median follow-up of 3 years, the estimated 5-year OS and EFS for the entire group were 58% and 49%, respectively. Twenty-eight patients (23%) had BMI > or = 28. Their median OS and EFS were 2.2 and 1.4 years, respectively, whereas median OS and EFS for the reference group have not been reached, with a 5-year projection of 65 and 55%, respectively (P < 0.002). On multivariate analysis, the risk of death among overweight patients was 2.9 (CI, 1.3-6.2) times that of the reference group; using EFS as the end point, a similar association between overweight and survival was observed. In conclusion, in high-risk NHL patients undergoing intensive chemotherapy and PBPC autografting overweight is associated with a poorer outcome.
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Affiliation(s)
- C Tarella
- Dipartimento di Medicina e Oncologia Sperimentale, Divisione Universitaria di Ematologia, Azienda Ospedaliera S Giovanni Battista, Torino, Italy
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