Childhood Obesity and Outcomes after Bone Marrow Transplantation for Patients with Severe Aplastic Anemia

Abstract

The prevalence of obesity in the pediatric population has increased in the last two decades and represents a serious health concern with potential impact on transplantation outcomes. We studied the effect of weight, by age-adjusted body mass index (BMI) percentiles on 1,281 pediatric patients (ages 2-19) with severe aplastic anemia transplanted between 1990 and 2005. The study population was divided into five 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 (26-75th 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 grades III-IV aGVHD. One- and two-year overall survival rates were 60% and 59% for overweight children, compared to rates greater than 70% in children with lower BMI at both time points (p<0.001). Other significant factors associated with survival included race and region, donor type, conditioning regimens in related donor transplants, performance score and year of transplant. 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 pre-transplant counseling.

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

“…Because chemotherapy dose adjustments based on weight to minimize toxicity are likely to differ between children and adults, the results of obesity studies in adult populations might not compare directly to studies in children. 9 In addition, these results of metaregression analysis might have also been affected by the heterogeneity of study settings and/or underlying disease characteristics.…”

“…Conditioning therapy without TBI was used in one article including one result. 16 Three studies from three articles used multivariate analysis, 9,15,18 whereas the remaining studies used univariate analysis alone. Two studies by Deeg et al 19 presented the combined results of autologous and allogeneic HSCT, and were excluded from aGVHD analysis.…”

“…6,7,9,[14][15][16][17][18][19][20][21]25,27,28 The definition of significant aGVHD was as follows: grade III-IV in three studies, 7,9,18 and grade II-IV in the remaining studies.…”

“…7,9,[14][15][16][17][18] All articles were published in the 21st century and were limited to allogeneic HSCT. This meta-analysis included eight adult studies.…”

“…6,7 More than a dozen observational studies have suggested that overweight and obese recipients are at increased risk of adverse HSCT outcomes, including acute graft-versus-host disease (aGVHD), transplantation-related toxicity, infectious complications and overall survival (OS). 8,9 To date, however, being overweight or obese has not been considered a proven risk factor in HSCT. 7 In this study, we conducted meta-analyses to evaluate the impact of obesity on aGVHD risk and OS in patients undergoing HSCT.…”