Effect of body mass in children with hematologic malignancies undergoing allogeneic bone marrow transplantation

Richard Aplenc, Mei Jie Zhang, Lillian Sung, Xiaochun Zhu, Vincent T. Ho, Kenneth Cooke, Christopher Dvorak, Gregory Hale, Luis M. Isola, Hillard M. Lazarus, Philip L. McCarthy, Richard Olsson, Michael Pulsipher, Marcelo C. Pasquini, Nancy Bunin

Research output: Contribution to journalArticlepeer-review

Abstract

The rising incidence of pediatric obesity may significantly affect bone marrow transplantation (BMT) outcomes. We analyzed outcomes in 3687 children worldwide who received cyclophosphamide-based BMT regimens for leukemias between 1990 and 2007. Recipients were classified according to age-adjusted body mass index (BMI) percentiles as underweight (UW), at risk of UW (RUW), normal, overweight (OW), or obese (OB). Median ageandrace were similar in all groups. Sixty-one percent of OB children were from the United States/Canada. Three-year relapse-free and overall survival ranged from 48% to 52% (P = .54) and 55% to 58% (P = .81) across BMI groups. Three-year leukemia relapses were 33%, 33%, 29%, 25%, and 21% in the UW, RUW, normal, OW, and OB groups, respectively (P < .001). Corresponding cumulative incidences for transplant-related mortality (TRM) were 18%, 19%, 21%, 22%, and 28% (P < .01). Multivariate analysis demonstrated a decreased risk of relapse compared with normal BMI (relative risk [RR] 5 0.73; P < .01) and a trend toward higher TRM (RR=1.28; P =.014). BMI in children is not significantly associated with different survival after BMT for hematologic malignancies. Obese children experience less relapse posttransplant compared with children with normal BMI; however, this benefit is offset by excess in TRM.

Original languageEnglish (US)
Pages (from-to)3504-3511
Number of pages8
JournalBlood
Volume123
Issue number22
DOIs
StatePublished - May 29 2014
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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