Biol Blood Marrow Transplant. 2018 Oct 10. pii: S1083-8791(18)30615-3. doi: 10.1016/j.bbmt.2018.10.006. [Epub ahead of print]

The Impact of Body Mass Index on the Outcome of Hematopoietic Stem Cell Transplantation in Adults.

Doney K¹, McMillen K², Buono L², Deeg HJ³, Gooley T³.

Abstract

This retrospective analysis of 2503 adult (≥20 years of age) allogeneic hematopoietic cell transplantation (HCT) recipients assessed the effect of body mass index (BMI) on transplant outcome. Median patient age was 51.7 years. Both nonmalignant and malignant diagnoses were included. Patients received either a myeloablative (52%) or reduced-intensity (48%) conditioning regimen. Donors were either related (42%) or unrelated (58%). Cord blood recipients were excluded. G-CSF mobilized peripheral blood cells were the stem cell source in 86% of transplants. GVHD prophylaxis included at least two immunosuppressive agents, one of which was a calcineurin inhibitor. Patient groups were categorized as underweight, normal weight, overweight, obese and very obese based on BMI. Endpoints included day 100 mortality, overall mortality, nonrelapse mortality (NRM) and relapse. Changes in nutritional status, based on laboratory parameters, were also examined. Underweight patients had significantly lower early and overall survival, and greater NRM. Very obese patients had increased NRM, which was associated with the intensity of the conditioning regimen. With long-term follow-up, increasing NRM was associated with both underweight and obese patients, compared to normal weight individuals. Changes in serum protein and albumin did not correlate with BMI. While enteral nutrition is now recommended for some undernourished patients, the efficacy of enteral or parenteral nutrition has not been well studied. For obese patients there are no guidelines regarding weight loss prior to transplantation, and acute weight loss in the pretransplant period may be detrimental.