title: Longitudinal changes in body mass and composition in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem-cell transplantation.
abstract: OBJECTIVE
  To measure longitudinal changes in body mass and composition in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem-cell transplantation (HSCT).
  
  
  METHODS
  Body mass index (BMI) was analyzed in 179 survivors by category (underweight, healthy-weight, overweight, and obese) and by z score. Fat and lean body mass measured by dual-energy x-ray absorptiometry was analyzed as z scores.
  
  
  RESULTS
  Over a median 6.6 years of follow-up, BMI z scores diminished significantly (0.32 pre-HSCT v -0.60 at 10 years post-HSCT; P < .001). Mean z scores for fat mass stayed within population norms, but those for lean mass remained below normal levels and diminished significantly over time (P = .018). Pre-HSCT BMI category and/or z score were strongly predictive of post-HSCT BMI (P < .001) and of fat and lean mass z scores (both P < .001). Survivors with extensive chronic graft-versus-host disease were more likely than others to have low BMI (P = .004) and low lean mass (P < .001) post-HSCT. Older age at HSCT (P = .015) and T-cell-depleted graft (P = .018) were predictive of lower post-HSCT BMI. Female patients had higher body fat (P = .002) and lower lean mass (P = .013) z scores than male patients, and black patients had higher fat mass z scores than white patients (P = .026).
  
  
  CONCLUSIONS
  BMI declines significantly after allogeneic HSCT for childhood hematologic malignancies, reflecting primarily a substantial decrease in lean mass but not fat mass. Monitoring and preservation of BMI and lean mass are vital, especially in those with the identified risk factors.
authors.affiliation: Department of Bone Marrow Transplantation and Cellular Therapy, MS 1130, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Inaba
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.forename: Sue C
authors.initials: SC
authors.lastname: Kaste
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hartford
authors.forename: Megan S
authors.initials: MS
authors.lastname: Motosue
authors.forename: Wassim
authors.initials: W
authors.lastname: Chemaitilly
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Triplett
authors.forename: David R
authors.initials: DR
authors.lastname: Shook
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Wing
authors.initials: W
authors.lastname: Leung
mesh_terms: D015502:Absorptiometry, Photon; D000273:Adipose Tissue; D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D012737:Sex Factors; D017741:Survivors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult