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. 2015 Dec 18;10(12):e0145445.
doi: 10.1371/journal.pone.0145445. eCollection 2015.

Weight Loss and Decrease of Body Mass Index during Allogeneic Stem Cell Transplantation Are Common Events with Limited Clinical Impact

Christina T Rieger  1 , Isabel Wischumerski  1 , Christian Rust  2 , Michael Fiegl  1
Affiliations

Weight Loss and Decrease of Body Mass Index during Allogeneic Stem Cell Transplantation Are Common Events with Limited Clinical Impact

Christina T Rieger et al. PLoS One. .

Abstract

Purpose: Weight loss in cancer patients has been attributed with significant morbidity and mortality. During allogeneic stem cell transplantation (SCT), oral nutrition is often hampered and hence total parenteral nutrition (TPN) is necessary. We therefore investigated the course of weight during stem cell transplantation and the clinical consequences of weight change.

Methods: 180 consecutive patients who received allogeneic SCT between January 2010 and December 2011 at our center were analyzed for weight loss, laboratory and clinical parameters.

Results: During SCT, a median decrease of 6.6% of body mass index (BMI) was observed for the whole population (from 25.3 at admission to 23.6 at discharge), and a 1.6fold increase of malnutrition despite use of TPN (28.3% to 45.0%). 55.6% of patients experienced a significant weight loss of ≥5% with a median decrease of 9.2% in BMI. Serum levels of albumin, total protein and cholesterol rapidly decreased during conditioning therapy. After a median of 2.4 years, the median BMI was still only 23.4 (not different from discharge). However, we did not observe a meaningful difference in side effects and survival between patients that did or did not lose weight.

Conclusion: Weight loss is commonly observed during allogeneic SCT despite TPN, but the clinical consequences thereof seem limited: we observed no significant impact on patients with a decrease ≥ 5% in BMI on transplant outcome, side effects or survival.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exists.

Figures

Fig 1
Fig 1. BMI change during allogeneic SCT.
A: Overall survival of the patient cohort. The median survival is not reached after 5 years of follow up. B: Significant decrease of BMI and body weight at discharge as compared to admission. C: A significant increase of patients with malnutrition during SCT was observed. D: The percentage of patients with malnutrition increases during the period of allogenic SCT (severity of malnutrition was graded according to ICD-10).
Fig 2
Fig 2. Distribution of weight loss and long-term follow-up.
A: App. 40% of patients decreased < 5% of BMI (considered not significant), but the majority lost ≥ 5% of BMI during SCT. B: In the group of patients whose BMI decreased, the loss was significantly 6.1fold higher. C: Overweight and obese patients lost significantly more weight than normal or underweight patients. D: Both BMI and body weight stayed at the same low level at discharge even during long term follow-up.
Fig 3
Fig 3. Serum levels of metabolic relevant parameters.
A: Significant decrease of total serum protein at the time point of transplantation, remaining low despite TPE. B: Similar results for serum albumin. C: Significant decrease of cholesterol, with recovery to pre-transplant values at the time point of discharge. Grey area encompasses normal range.
Fig 4
Fig 4. Clinical consequences of weight loss during stem cell transplantation.
A: No difference in overall survival between patients that lose ≥ 5% of BMI during SCT B: Similar result for a BMI decrease of ≥ 10%. C: No significant difference for leukopenia, thrombocytopenia or days in hospital according to BMI decrease. D: No significant difference in overall survival according to weight at admission.
See this image and copyright information in PMC

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