Relationship of Body Mass Index and Arm Anthropometry to Outcomes after Pediatric Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies

Abstract

Although nutritional status may adversely affect various health outcomes, the relationship between anthropometry and outcomes after hematopoietic cell transplantation (HCT) has not been fully studied in children. We analyzed the impact of pre-HCT body mass index (BMI), arm muscle area, and arm fat area on outcomes in 733 patients age 2-18 years who underwent allogeneic HCT for a hematologic malignancy between 1985 and 2009. We evaluated these 3 variables according to patient group based on age- and sex-adjusted percentiles for BMI, arm muscle area (<5th, 5th-24th, 25th-94th, and ≥95th), and arm fat area (<25th, 25th-94th, and ≥95th). Cox proportional hazards regression models for event-free survival (EFS), relapse, and nonrelapse mortality (NRM) at 100 days and 3 years after HCT, as well as grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD, were performed using the 3 major variables and adjusted for covariates. BMI was <5th percentile in only 3% of patients and ≥95th percentile in 15% of patients, but outcomes for both groups were similar to those for the BMI 25th-94th percentile group. The BMI 5th-24th percentile group had lower EFS (P = .01) and higher relapse (P = .003) at day +100 post-HCT, but these associations did not hold at 3 years post-HCT. Arm muscle area was <5th percentile in 8% of patients, and arm fat area was <25th percentile in 10%. Analysis of arm muscle area showed that the <5th percentile group had lower EFS and higher NRM and relapse rate at day +100 (P = .002, .04, and .01, respectively) and 3 years (P = .0004, .008, and .01, respectively) post-HCT. Arm fat area <25th percentile was associated with lower EFS at day +100 (hazard ratio, 1.5; P = .05), but not at 3 years post-HCT. Anthropometry variables were not associated with acute or chronic GVHD. In conclusion, arm muscle area <5th percentile appears to be a stronger predictor than BMI of poor outcomes after HCT in children with hematologic malignancies.

Design and Validation of an Augmented Hematopoietic Cell Transplantation-Comorbidity Index Comprising Pretransplant Ferritin, Albumin, and Platelet Count for Prediction of Outcomes after Allogeneic Transplantation

“…Supporting the inference that the effect of low albumin on outcome is dictated by its correlation with nutritional status are previous studies which show the importance of pre-HCT nutritional status to OS after HCT using more specific measurement tools such as BMI, bioimpedance and anthropometry [39–41]. As with ferritin, the prognostic value of serum albumin highlights a potential area of intervention (for example, aggressive nutritional supplementation pre-HCT) that could be targeted to improve outcome.…”

Impact of pretransplant body mass index on the clinical outcome after allogeneic hematopoietic SCT

“…32,36,37 A recent study reported that pretransplant low arm muscle area was a stronger predictor than BMI of poor outcomes after HCT in children with hematologic malignancies. 38 The impact of pretransplant BMI, anthropometric measures and change of body weight should be assessed in the future studies.…”

Pre-transplant arm muscle area: a simple measure to identify patients at risk

“…Inadequate nutritional status may increase the length of stay, as well as the risks of infections and mortality in hospitalized patients [9,13]. The nutritional deficit shown by the body mass index (BMI) and arm muscle area (AMA) has been associated with acute GVHD and relapse rate of the disease up to 100 days after transplant in pediatric patients [14]. Furthermore, the association of low oral food intake with development of severe GVHD after HSCT has also been observed [15].…”