Effect of body mass in children with hematologic malignancies undergoing allogeneic bone marrow transplantation.
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.
Children's Hospital of Philadelphia, Philadelphia, PA;
Richard
R
Aplenc
Center for International Blood and Marrow Transplant Research, Milwaukee, Medical College of Wisconsin, Milwaukee, WI;
Mei-Jie
MJ
Zhang
The Hospital for Sick Children, Toronto, Canada;
Lillian
L
Sung
Center for International Blood and Marrow Transplant Research, Milwaukee, Medical College of Wisconsin, Milwaukee, WI;
Xiaochun
X
Zhu
Dana Farber Cancer Institute, Boston, MA;
Vincent T
VT
Ho
Case Western Reserve University, Cleveland, OH;
Kenneth
K
Cooke
University of California San Francisco, San Francisco, CA;
Christopher
C
Dvorak
All Children's Hospital, St Petersburg, FL;
Gregory
G
Hale
Mt Sinai Hospital, New York, NY;
Luis M
LM
Isola
Case Western Reserve University, Cleveland, OH;
Hillard M
HM
Lazarus
Roswell Park Cancer Institute, Buffalo, NY;
Philip L
PL
McCarthy
Karolinska Institute, Stockholm, Sweden; and.
Richard
R
Olsson
University of Utah School of Medicine, Salt Lake City, UT.
Michael
M
Pulsipher
Center for International Blood and Marrow Transplant Research, Milwaukee, Medical College of Wisconsin, Milwaukee, WI;
Marcelo C
MC
Pasquini
Children's Hospital of Philadelphia, Philadelphia, PA;
Nancy
N
Bunin
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D015992:Body Mass Index; D001835:Body Weight; D016026:Bone Marrow Transplantation; D002170:Canada; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D063766:Pediatric Obesity; D012008:Recurrence; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States