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Effect of body mass in children with hematologic malignancies undergoing allogeneic bone marrow transplantation
Richard Aplenc1, Mei-Jie Zhang2, Lillian Sung3
1Children's Hospital of Philadelphia, Philadelphia, PA;
Insights
Pediatric obesity does not significantly impact survival after bone marrow transplantation (BMT) for leukemia. While obese children have fewer relapses, they face a higher risk of transplant-related mortality, offsetting survival benefits.
Area of Science:
- Pediatric Hematology Oncology
- Transplantation Immunology
- Pediatric Endocrinology
Background:
- Pediatric obesity rates are increasing globally.
- The impact of body mass index (BMI) on pediatric bone marrow transplantation (BMT) outcomes is not fully understood.
- Understanding these associations is crucial for optimizing BMT protocols in children.
Purpose of the Study:
- To investigate the association between pre-transplant body mass index (BMI) and outcomes in children undergoing bone marrow transplantation (BMT) for leukemia.
- To analyze the effects of BMI on leukemia relapse rates and transplant-related mortality (TRM).
- To determine if BMI influences overall survival post-BMT.
Main Methods:
- Retrospective analysis of 3687 pediatric patients receiving cyclophosphamide-based BMT for leukemia (1990-2007).
- Patients categorized into underweight, at risk of underweight, normal, overweight, and obese groups based on age-adjusted BMI percentiles.
- Outcomes including relapse-free survival, overall survival, leukemia relapse, and TRM were compared across BMI groups.
Main Results:
- No significant difference in 3-year relapse-free or overall survival across BMI groups.
- Leukemia relapse rates were significantly lower in overweight (25%) and obese (21%) children compared to normal BMI (29%).
- Transplant-related mortality (TRM) showed a significant increase with higher BMI, reaching 28% in obese children versus 21% in normal BMI.
Conclusions:
- Pediatric BMI is not significantly associated with overall survival after BMT for hematologic malignancies.
- Obese children experience a reduced risk of leukemia relapse post-BMT.
- The benefit of reduced relapse in obese children is counterbalanced by an increased risk of TRM, negating a survival advantage.
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 age and race 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] = 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.
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