Le Blanc Katarina, Ringdén Olle, Remberger Mats
Center for Allogeneic Stem Cell Transplantation, Division of Clinical Immunology, F79, Karolinska Institutet, Huddinge University Hospital, SE-141 86, Stockholm, Sweden.
Haematologica. 2003 Sep;88(9):1044-52.
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).
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.
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.
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.
本研究旨在确定体重指数（BMI，千克体重/身高²（米））是否与异基因干细胞移植（ASCT）受者的生存率相关。
自1977年以来，544例成年患者（年龄在18至64岁之间）被诊断患有血液系统恶性肿瘤；其中172例急性髓细胞白血病，83例急性淋巴细胞白血病，190例慢性髓细胞白血病，99例其他类型，接受了清髓性预处理和ASCT。88例患者BMI较低（<20），290例患者BMI正常（20 - 25），166例患者BMI较高（>25）。供者为348例 HLA 相同的同胞，157例匹配的无关供者和39例 HLA 主要错配供者。我们使用Cox回归模型评估BMI作为控制其他与移植相关死亡率、生存率和无复发生存率风险因素的风险因素。
BMI较低的患者更常患急性淋巴细胞白血病，年龄更小，更常接受全身照射，且更常接受单一疗法作为预防移植物抗宿主病的免疫抑制。BMI对植入、输血以及急性或慢性移植物抗宿主病无影响。BMI <20的患者比BMI≥20的患者α - 链球菌败血症发生率更高（p = 0.005），但两组总体菌血症发生率相似。BMI较低者五年生存率为36%，BMI正常者为47%，BMI较高者为55%。在多变量分析中，死亡与BMI <20相关（p = 0.023）。其他经调整的显著因素包括：急性淋巴细胞白血病的诊断、非HLA相同同胞的供者、首次完全缓解期或第1慢性期之外的疾病阶段、1993年前的移植以及全身照射与白消安预处理。
低BMI（<20）与ASCT后移植相关死亡率增加、生存率和无复发生存率降低显著相关。在分析ASCT后的结果时应考虑BMI。
