title: Effectiveness and toxicity of high-dose cyclophosphamide in obese versus non-obese patients receiving allogeneic hematopoietic stem cell transplant.
abstract: OBJECTIVE
  To determine if there is a difference in toxicity and effectiveness between obese and non-obese patients who receive high-dose cyclophosphamide (Cy) prior to allogeneic hematopoietic stem cell transplant (allo-HCT).
  
  
  METHODS
  Patients were included in this study if they were at least 18 years of age and received high-dose Cy in combination with total body irradiation (CyTBI) or busulfan (BuCy) prior to allo-HCT between 1 January 2008 and 29 February 2012. The primary endpoint was the difference in overall toxicity between obese and non-obese patients. Secondary objectives examined differences in effectiveness between groups assessed by relapse at day +100, relapse at 1 year, death at 1 year, chimerisms at days +30, +60, and +90, and incidence of acute graft versus host disease (aGVHD).
  
  
  RESULTS
  Sixty-one patients met the inclusion criteria, 28 obese and 33 non-obese. Overall toxicity was greater in obese patients compared to non-obese patients (82% vs. 52%, OR 4.3 [95% CI 1.3-14.1]; p = 0.01), which was driven by a greater incidence of renal dysfunction (79% vs. 48%, OR 3.9 [95% CI 1.3-12.1]; p = 0.02). There were no differences in rates of grade 3 or 4 toxicity, hepatic dysfunction, or any measure of effectiveness between groups.
  
  
  CONCLUSIONS
  Obese patients receiving high-dose Cy and allo-HCT are at increased risk for toxicity, although there appears to be no difference in the rate of relapse or survival between obese and non-obese patients.
authors.affiliation: Department of Pharmacy Services, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA melissa.hunter2@imail.org.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Hunter
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Roy T
authors.initials: RT
authors.lastname: Sabo
authors.affiliation: Bone Marrow Transplant Program, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals; Richmond, VA, USA Hematology-Oncology, Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: McCarty
authors.affiliation: Department of Pharmacy Services, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA Hematology/Oncology, Health System/Medical College of Virginia Hospitals, Virginia Commonwealth University Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Newland
mesh_terms: D000328:Adult; D002066:Busulfan / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D009765:Obesity / Q000503:physiopathology*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods; D014916:Whole-Body Irradiation / Q000379:methods
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D002066:Busulfan
keywords: Cyclophosphamide; allogeneic hematopoietic stem cell transplant; effectiveness; obesity; toxicity