title: Effect of obesity on outcomes after autologous hematopoietic stem cell transplantation for multiple myeloma.
abstract: Obesity has implications for chemotherapy dosing and selection of patients for therapy. Autologous hematopoietic stem cell transplant (AutoHCT) improves outcomes for patients with multiple myeloma, but optimal chemotherapy dosing for obese patients is poorly defined. We analyzed the outcomes of 1087 recipients of AutoHCT for myeloma reported to the CIBMTR between 1995 and 2003 who received high-dose melphalan conditioning, with or without total body irradiation (TBI). We categorized patients by body mass index (BMI) as normal, overweight, obese, or severely obese. There was no overall effect of BMI on progression-free survival (PFS), overall survival (OS), progression, or nonrelapse mortality (NRM). In patients receiving melphalan and TBI conditioning, obese and severely obese patients had superior PFS and OS compared with normal and overweight patients, but the clinical significance of this finding is unclear. More obese patients were more likely to receive a reduced dose of melphalan, but there was no evidence that melphalan or TBI dosing variability affected PFS. Therefore, current common strategies of dosing melphalan do not impair outcomes for obese patients, and obesity should not exclude patients from consideration of autologous transplantation. Further research is necessary to optimize dosing of both chemotherapy and radiation in obese patients.
authors.affiliation: Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. dan.vogl@uphs.upenn.edu
authors.forename: Dan T
authors.initials: DT
authors.lastname: Vogl
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Heitjan
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Ram
authors.initials: R
authors.lastname: Kamble
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisdorf
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: Karen
authors.initials: K
authors.lastname: Ballen
authors.forename: Leona
authors.initials: L
authors.lastname: Holmberg
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Cesar
authors.initials: C
authors.lastname: Freytes
authors.forename: Dipnarine
authors.initials: D
authors.lastname: Maharaj
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.forename: David
authors.initials: D
authors.lastname: Vesole
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Hari
mesh_terms: D015992:Body Mass Index; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D008558:Melphalan