A low body mass index is correlated with poor survival after allogeneic stem cell transplantation

Abstract

Background and objectives: The purpose of this study was to determine whether body mass index (BMI, kg body weight/height (in m2) is related to survival in recipients of allogeneic stem cell transplantation (ASCT).

Design and methods: Since 1977, 544 adult patients (age ranging from 18 to 64 years) diagnosed with hematologic malignancies; 172 acute myeloid leukemia, 83 acute lymphocytic leukemia, 190 chronic myeloid leukemia and 99 others, underwent myeloablative conditioning and ASCT. Low BMI (<20) was seen in 88 patients, normal BMI (20-25) in 290 and high BMI (>25) in 166 patients. The donors were 348 HLA-identical siblings, 157 matched unrelated donors and 39 HLA major mismatched donors. We assessed BMI as a risk-factor controlling for other risk-factors regarding transplant-related mortality, survival and relapse-free survival using the Cox regression model.

Results: Patients with a low BMI more often had ALL, were younger, were more often conditioned with total body irradiation and more often received monotherapy as immunosuppression against graft-versus-host disease. BMI had no effect on engraftment, transfusions and acute or chronic GVHD. Patients with BMI <20 had a higher incidence of a-streptococcal septicemia (p=0.005) than did patients with BMI > or = 20, but both groups had a similar incidence of overall bacteremia. Five-year survival was 36% in those with low BMI, 47% in those with normal BMI and 55% in those with high BMI. In multivariate analysis, death was associated with BMI <20 (p=0.023). Other significant factors adjusted for were: diagnosis of acute lymphoblastic leukemia, donors other than HLA-identical siblings, disease stage beyond first complete remission or 1st chronic phase, transplantation before 1993 and total body irradiation vs. busulfan conditioning.

Interpretation and conclusions: A low BMI (<20) was significantly correlated with an increased transplant-related mortality, a decreased survival and relapse-free survival after ASCT. BMI should be considered when analyzing outcome after ASCT.