Outcomes after autologous SCT in lymphoma patients grouped by weight

Abstract

Obesity continues to be an increasing global health issue contributing to the complexity of chemotherapy dosing in the field of SCT. Investigation into the optimal dosing weight used to calculate chemotherapy doses in obese patients undergoing SCT is limited and inconclusive. Our single-center, retrospective study compared safety and efficacy outcomes by body mass index (BMI) for 476 adult lymphoma patients who underwent auto-SCT with a myeloablative chemotherapeutic regimen of BU, CY and etoposide dosed using adjusted body weight. Three weight groups categorized based on BMI were defined: normal/underweight ⩽ 24.9 kg/m 2 , overweight 25-29.9 kg/m 2 and obese ⩾ 30 kg/m 2 . Severity of mucositis, incidence of secondary malignancy, incidence of bacteremia and median hospital length of stay did not differ among the groups. The median times to absolute neutrophil count and platelet recovery were 10 days (P = 0.75) and 14 days (P = 0.17), respectively. Obese patients had a lower 100-day mortality compared with other weight groups, although this did not translate into an OS benefit. OS and disease relapse were similar among the groups. Our study demonstrates that use of adjusted body weight to calculate chemotherapy doses does not negatively have an impact on outcomes in obese patients undergoing auto-SCT with BU, CY and etoposide.

Adjusting Cyclophosphamide Dose in Obese Patients with Lymphoma Is Safe and Yields Favorable Outcomes after Autologous Hematopoietic Cell Transplantation

“…Others have suggested that severe obesity is a poor prognostic factor for hematopoietic transplantation [17], yet this and another recent study using appropriate dose adjustments failed to show increased risk of serious complications for the severely obese treated with autologous HCT [18]. There are significant differences between our study and other reports.…”

Body mass index does not impact hematopoietic progenitor cell mobilization for autologous hematopoietic cell transplantation

“…On a similar note, studies investigating the impact of obesity on AHCT outcomes are heterogeneous with different results . Two large studies from the Center for International Blood and Marrow Transplant Research (CIBMTR) that have looked at AHCT outcomes of large cohorts of patients with lymphoma and myeloma showed comparable results .…”

“…3,4 Studies evaluating transplant outcomes and survival of obese patients have had mixed findings with large cohort studies showing at least similar outcomes to normal-weight patients. [5][6][7][8][9][10][11][12][13] Several factors leading to poor peripheral blood hematopoietic progenitor cell (HPC) mobilization have been reported. [14][15][16][17][18] A potentially significant, yet understudied factor is obesity, which may have a bearing on HPC mobilization via its effect on the interaction of the hematopoietic stem cell niche and its microenvironment, the need for a higher CD34+ cell dose based on actual body weight and alteration of mobilization agent pharmacokinetics.…”

A time to stop, a time to start: high-dose chemotherapy in overweight and obese patients

“…Secondary malignancy, a potential long-term toxicity that might be expected to increase with increasing doses of chemotherapy, showed no significant differences associated with weight in 5-year cumulative incidence, and there was no development of any unique type of malignancy. 14 No specific anatomical or molecular markers of post-transplant residual tumor mass are available to determine specific antitumor effects of adjusted weight antitumor therapy. However, as the relapse rates in the three weight groups, at 1, 3 and 5 years, were not significantly different, these results suggest the probability that the increased drug dose associated with obesity was at least as effective in attaining the same degree of tumor control as the more standard dose given to normal weight patients.…”

“…In fact, obese patients who presumably received the highest amounts of chemotherapeutic agents showed a decrease in 100-day mortality relative to normal or overweight patients, but no significant difference in relapse-free survival or OS. 14 In this single-center, retrospective study of the safety and efficacy of auto-SCT in 476 adult lymphoma patients, all drugs were dosed on the basis of Adj BW in which 25% of the difference between TBW and IBW was added to the patient's IBW to determine Adj BW (Adj BW = IBW+0.25 (TBW − IBW)), which was then used as the basis for dose calculations.…”