title: 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 2 decades and represents a serious health concern, with potential impact on outcomes of hematopoietic cell transplantation (HCT). We studied the effect of weight by age-adjusted body mass index (BMI) percentile in 1,281 pediatric patients (age 2-19 years) with severe aplastic anemia who underwent HCT between 1990 and 2005. The study population was divided into 5 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 (26th-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 grade III-IV aGVHD. The 1-year and 2-year overall survival rates were 60% and 59% for overweight children, compared with >70% in children with lower BMI at both time points (P < .001). Other significant factors associated with survival included race and region, donor type, conditioning regimens in related donor transplants, performance score, and year of transplantation. 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 pretransplantation counseling.
authors.affiliation: British Colombia Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Collin C
authors.initials: CC
authors.lastname: Barker
authors.forename: Manza-A
authors.initials: MA
authors.lastname: Agovi
authors.forename: Brent
authors.initials: B
authors.lastname: Logan
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
authors.forename: Vincent
authors.initials: V
authors.lastname: Ho
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
mesh_terms: D000293:Adolescent; D000741:Anemia, Aplastic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015992:Body Mass Index; D016026:Bone Marrow Transplantation / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D044469:Racial Groups; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013851:Thinness / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Bone Marrow Transplant. 2000 Dec;26(11):1185-91
references.pmid: 11149729
references.citation: Int J Pediatr Obes. 2006;1(1):26-32
references.pmid: 17902212
references.citation: Biol Blood Marrow Transplant. 2006 Aug;12(8):876-84
references.pmid: 16864058
references.citation: Am J Med. 1997 Mar;102(3):265-8
references.pmid: 9217595
references.citation: JAMA. 2005 Jan 12;293(2):203-11
references.pmid: 15644547
references.citation: Biol Blood Marrow Transplant. 2010 Oct;16(10):1442-50
references.pmid: 20412867
references.citation: Blood. 2005 Oct 15;106(8):2912-9
references.pmid: 15994282
references.citation: Biol Blood Marrow Transplant. 2006 May;12(5):541-51
references.pmid: 16635789
references.citation: Transplantation. 1974 Oct;18(4):295-304
references.pmid: 4153799
references.citation: Br J Haematol. 2005 Sep;130(5):747-51
references.pmid: 16115132
references.citation: Bone Marrow Transplant. 2001 Aug;28(4):365-7
references.pmid: 11571508
references.citation: Pediatrics. 2002 Jan;109(1):45-60
references.pmid: 11773541
references.citation: Biol Blood Marrow Transplant. 2009 Jan;15(1):73-82
references.pmid: 19135945
references.citation: J Pediatr. 1998 Feb;132(2):204-10
references.pmid: 9506629
references.citation: JAMA. 2008 May 28;299(20):2401-5
references.pmid: 18505949
references.citation: Br J Haematol. 2008 Jan;140(2):214-7
references.pmid: 18028482
references.citation: Am J Clin Nutr. 2002 Jun;75(6):978-85
references.pmid: 12036802
references.citation: Biol Blood Marrow Transplant. 2008 Jul;14(7):748-58
references.pmid: 18541193
references.citation: J Clin Oncol. 2007 May 20;25(15):2063-9
references.pmid: 17513811