Childhood obesity and outcomes after bone marrow transplantation for patients with severe aplastic anemia.

Barker CC, Agovi MA, Logan B, Lazarus HM, Ballen KK, Gupta V, Hale GA, Frangoul H, Ho V, Rizzo JD, Pasquini MC, Regimen-Related Toxicity Writing Committee, Center for International Blood and Marrow Transplant Research
Biol Blood Marrow Transplant. 2011 17 (5): 737-44

PMID: 20817111 · PMCID: PMC3035737 · DOI:10.1016/j.bbmt.2010.08.019

The prevalence of obesity in the pediatric population has increased in the last 2 decades and represents a serious health concern, with potential impact on outcomes of hematopoietic cell transplantation (HCT). We studied the effect of weight by age-adjusted body mass index (BMI) percentile in 1,281 pediatric patients (age 2-19 years) with severe aplastic anemia who underwent HCT between 1990 and 2005. The study population was divided into 5 weight groups-underweight, risk of underweight, normal BMI range, risk of overweight, and overweight-according to age-adjusted BMI percentiles. Cox proportional hazards regression models for survival and acute graft-versus-host disease (aGVHD), performed using weight groups as the main effect and the normal BMI range (26th-75th percentile) as the baseline comparison, found higher mortality among overweight children (>95th percentile adjusted for age). Weight at transplantation did not increase the adjusted risk of grade III-IV aGVHD. The 1-year and 2-year overall survival rates were 60% and 59% for overweight children, compared with >70% in children with lower BMI at both time points (P < .001). Other significant factors associated with survival included race and region, donor type, conditioning regimens in related donor transplants, performance score, and year of transplantation. In conclusion, overweight children with aplastic anemia have worse outcomes after HCT. The impact of obesity on survival outcomes in children should be discussed during pretransplantation counseling.

Copyright © 2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

MeSH Terms (20)

Adolescent Anemia, Aplastic Body Mass Index Bone Marrow Transplantation Child Child, Preschool Continental Population Groups Female Graft vs Host Disease Hematopoietic Stem Cell Transplantation Humans Male Multivariate Analysis Obesity Retrospective Studies Severity of Illness Index Survival Rate Thinness Treatment Outcome Young Adult

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