title: Chemotherapy dose adjustment for obese patients undergoing hematopoietic stem cell transplantation: a survey on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
abstract: BACKGROUND
  Appropriate chemotherapy dosing for obese patients with malignant diseases is a significant challenge because limiting chemotherapy doses in these patients may negatively influence outcome. There is a paucity of information addressing high-dose chemotherapy in obese patients undergoing hematopoietic stem cell transplantation (HSCT).
  
  
  METHODS
  The Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) designed an electronic survey to assess current practice of dose adjustment of chemotherapy in obese patients undergoing HSCT.
  
  
  RESULTS
  A total of 56 EBMT centers from 27 countries responded to the online survey. Overall, 45 centers declared that they routinely adjust chemotherapy doses for obese patients (80.5%), and only 11 (19.5%) declared they do not adjust dose. Among the former group, most used body mass index as the parameter for defining obesity (28 centers, 62%). The method for determining the weight for chemotherapy calculation was actual body weight (ABW) in 16 centers, ideal body weight (IBW) in 10 centers, IBW plus 25% of the difference between IBW and ABW in 16 centers, and other methods for the rest. Among centers that used dose adjustment, 44% also capped the dose at 2 m(2) for a chemotherapy dose based on body surface area (BSA), whereas 56% did not cap. Interestingly, most of the centers (9 of 11) that did not adjust dose for weight also did not cap the BSA at 2 m(2).
  
  
  CONCLUSIONS
  This EBMT survey revealed large diversity among transplant centers regarding dose-adjustment practice for high-dose conditioning chemotherapy. Our next step is to analyze outcomes of transplantation according to dose-adjustment practice and, subsequently, to formulate a methodology for future prospective studies.
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany noga.shemtov@sheba.health.gov.il.
authors.forename: Noga
authors.initials: N
authors.lastname: Shem-Tov
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Leila
authors.initials: L
authors.lastname: Moukhtari
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Jordi
authors.initials: J
authors.lastname: Esteve
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Giebel
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Norbert-Claude
authors.initials: NC
authors.lastname: Gorin
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Avichai
authors.initials: A
authors.lastname: Shimoni
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel; EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France; San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy; Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
mesh_terms: D001853:Bone Marrow / Q000473:pathology; D003625:Data Collection; D004305:Dose-Response Relationship, Drug; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D009765:Obesity / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
keywords: Conditioning; Dose adjustment; Hematopoietic stem cell transplantation; Obesity