Navarro Willis H, Loberiza Fausto R, Bajorunaite Ruta, van Besien Koen, Vose Julie M, Lazarus Hillard M, Rizzo J Douglas
University of California, San Francisco, San Francisco, California 94080-4990, and University Hospitals of Cleveland, OH, USA.
Biol Blood Marrow Transplant. 2006 May;12(5):541-51. doi: 10.1016/j.bbmt.2005.12.033.
High-dose therapy with autologous hematopoietic cell transplantation (auto-HCT) is frequently used to improve outcomes in lymphoma. However, small studies suggest a survival disadvantage among obese patients. Using a retrospective cohort analysis, we studied the outcomes of 4681 patients undergoing auto-HCT for Hodgkin or non-Hodgkin lymphoma between 1990 and 2000 according to body mass index (BMI). Four groups categorized by BMI were compared by using Cox proportional hazards regression to adjust for other prognostic factors. A total of 1909 patients were categorized as normal weight (BMI 18-25 kg/m2), 121 as underweight (BMI<18 kg/m2), 1725 as overweight (BMI>25-30 kg/m2), and 926 as obese (BMI>30 kg/m2) at the time of HCT. Outcomes evaluated included overall survival, relapse, transplantation-related mortality (TRM), and lymphoma-free survival. TRM was similar among the normal, overweight, and obese groups; the underweight group had a higher risk of TRM (relative risk [RR], 2.46; 95% confidence interval [CI], 1.59-3.82; P<0.0001) compared with the normal-BMI group. No differences in relapse were noted. Overall mortality was higher in the underweight group (RR, 1.48; 95% CI, 1.17-1.88; P=.001) and lower in the overweight (RR, 0.87; 95% CI, 0.79-0.96; P=.004) and obese (RR, 0.76; 95% CI, 0.67-0.86; P<.0001) groups compared with the normal-BMI group. In light of our inability to find differences in survival among overweight, obese, and normal-weight patients, obesity alone should not be viewed as a contraindication to proceeding with auto-HCT for lymphoma when it is otherwise indicated.
高剂量自体造血细胞移植（auto-HCT）疗法常用于改善淋巴瘤的治疗效果。然而，小规模研究表明肥胖患者存在生存劣势。我们采用回顾性队列分析方法，根据体重指数（BMI）研究了1990年至2000年间4681例接受auto-HCT治疗霍奇金淋巴瘤或非霍奇金淋巴瘤患者的治疗结果。通过Cox比例风险回归对BMI分类的四组患者进行比较，以调整其他预后因素。共有1909例患者在HCT时被分类为正常体重（BMI 18-25 kg/m²），121例为体重过轻（BMI<18 kg/m²），1725例为超重（BMI>25-30 kg/m²），926例为肥胖（BMI>30 kg/m²）。评估的结果包括总生存期、复发率、移植相关死亡率（TRM）和无淋巴瘤生存期。正常、超重和肥胖组的TRM相似；与正常BMI组相比，体重过轻组的TRM风险更高（相对风险[RR]，2.46；95%置信区间[CI]，1.59-3.82；P<0.0001）。未观察到复发率的差异。体重过轻组的总死亡率更高（RR，1.48；95% CI，1.17-1.88；P=0.001），与正常BMI组相比，超重（RR，0.87；95% CI，0.79-0.96；P=0.004）和肥胖（RR，0.76；95% CI，0.67-0.86；P<0.0001）组的总死亡率更低。鉴于我们未能发现超重、肥胖和正常体重患者在生存方面的差异，如果有其他指征，肥胖本身不应被视为进行淋巴瘤auto-HCT的禁忌证。
