The effect of obesity on outcome of unrelated cord blood transplant in children with malignant diseases. Bone Marrow Transplant

Department of Pediatrics, Division of Pediatric Hematology/Oncology, Pediatric Stem Cell Transplant Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Bone marrow transplantation (Impact Factor: 3.57). 12/2010; 46(10):1309-13. DOI: 10.1038/bmt.2010.312
Source: PubMed


Obesity has become a pandemic, affecting both children and adults. We sought to determine the effect of obesity among 200 children who were prospectively enrolled on a multicenter cord blood transplant (CBT) trial. All patients received myeloablative preparative regimens. Children were classified into groups according to body mass index percentile. Normal weight was defined as body mass index between the 5th and 85th percentile (n=117), overweight between the 85th and 95th percentile (n=35) and obesity above 95th percentile (n=39) for age and gender. A total of 55 patients (27%) had AML, 113 patients (57%) had ALL and 32 patients (16%) had other malignant diseases. There was no evidence for a difference in all major characteristics among the groups. Time to neutrophil and platelet engraftment, TRM, risk of acute GVHD, disease-free survival and OS were not significantly different in overweight or obese patients compared with normal weight patients. There was a trend towards increased risk of chronic GVHD in obese patients (P=0.05) compared with normal weight patients. In conclusion, there is insufficient evidence from this sample that obesity has an effect on multiple outcomes after unrelated CBT in children with malignant diseases.

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Available from: Frank E Harrell, Mar 31, 2015
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    ABSTRACT: Hematopoietic cell transplantation (HCT) is a high-risk procedure of curative potential for patients with various malignant and nonmalignant hematological diseases. Because the procedure carries considerable risks of treatment-related morbidity and mortality and has variable results in improving disease-free survival, patient selection plays an important role in its success. One patient factor that has received attention in the last 20 years has been the concern that obese patients may not have outcomes similar to normal weight individuals because of (1) altered pharmacokinetics of commonly used chemotherapeutic agents [1, 2], (2) presence of other medical comorbidities with obesity [3], and (3) higher morbidity associated with obesity itself [4], which may result in higher post-HCT morbidity/mortality. Because obesity has become a pandemic affecting both children and adults in the United States and worldwide [5–8], the body of literature evaluating the relationship between obesity and clinical outcomes in the setting of HCT has grown as well. This chapter explores the pharmacokinetics, pharmacodynamics, and clinical outcomes of HCT in the setting of obesity.
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