Haematology Department Heart of England NHS trust, Birmingham, UK.
Ann Hematol. 2010 Nov;89(11):1141-5. doi: 10.1007/s00277-010-1001-6. Epub 2010 Jun 11.
Bone marrow transplantation is frequently used as a consolidation therapy in patients with haematological malignancies to improve the outcome of these patients. Obese individuals have larger absolute lean body and fat masses than non-obese individuals of the same age, gender and height, which might lead to altered pharmacokinetics of chemotherapeutic agents. Data on the impact of body mass on transplant outcome is conflicting. This study included 331 patients (M, 230; F, 101) with 336 allogeneic transplant episodes from two large teaching hospitals in the West Midlands region in United Kingdom. A total of 105 patients had acute myeloid leukaemia, 83 had non-Hodgkin's lymphoma, three had myeloma, 21 had Hodgkin's lymphoma, 34 had acute lymphoblastic leukaemia, 19 had chronic myeloid leukaemia, 22 had chronic lymphocytic leukaemia, 24 had myelodysplasia, seven had T cell non-Hodgkin's lymphoma, six had aplastic leukaemia and seven had myelofibrosis. At transplantation, 40% (N = 133) of the patients had normal and 60% (N = 198) had high body mass index (BMI) with 14% of the patients being obese (BMI >30). After a median follow-up of 24 months (range, 2-79), the mean overall survival (OS) in patients undergoing allograft with normal BMI was 31 months as compared to 39 with high BMI (p:0.06). The mean progression free survival (PFS) in patients undergoing allograft with normal BMI was 33 months as compared to 38 with high BMI (p = 0.13). Of the patients in the high and obese BMI group, 16% developed acute GvHD with 8% grade III-IV and 28% in the normal BMI group with 14% grade III-IV acute GvHD (p = 0.11). Of the patients in the high BMI group, 17% developed chronic GvHD and 30% of the patients in the normal BMI group (p = 0.09). However, higher infection rates and more days of inpatient stay in the first year post-transplant were observed in the high BMI and obese patients, but there was no difference in ITU admissions. This study shows that high BMI and obesity does not adversely impact on either OS or PFS in patients undergoing allogeneic transplantation for haematological malignancies, but it does have a significant impact on infection rates and hospitalisation of high BMI and obese patients. We recommend that patients with high BMI should not be excluded from allogeneic transplantation; however, good supportive care and careful patient selection on the basis of comorbidity index should be undertaken in order to avoid the risks from the increased rates of infection.
骨髓移植常用于血液系统恶性肿瘤患者的巩固治疗，以改善这些患者的预后。肥胖个体的瘦体重和体脂质量比同年龄、性别和身高的非肥胖个体更大，这可能导致化疗药物的药代动力学发生改变。关于体重对移植结果影响的数据存在争议。本研究纳入了来自英国西米德兰兹地区 2 家大型教学医院的 331 例（男 230 例，女 101 例）接受同种异体移植的患者及其 336 个移植病例。105 例患者患有急性髓系白血病，83 例患有非霍奇金淋巴瘤，3 例患有骨髓瘤，21 例患有霍奇金淋巴瘤，34 例患有急性淋巴细胞白血病，19 例患有慢性髓系白血病，22 例患有慢性淋巴细胞白血病，24 例患有骨髓增生异常综合征，7 例患有 T 细胞非霍奇金淋巴瘤，6 例患有再生障碍性贫血，7 例患有骨髓纤维化。移植时，40%（N=133）的患者体质量指数（BMI）正常，60%（N=198）的患者 BMI 较高，14%的患者肥胖（BMI>30）。中位随访 24 个月（范围：2-79 个月）后，BMI 正常的患者的总生存（OS）为 31 个月，BMI 较高的患者为 39 个月（p：0.06）。BMI 正常的患者无进展生存（PFS）为 33 个月，BMI 较高的患者为 38 个月（p=0.13）。在 BMI 较高和肥胖组中，16%的患者发生急性移植物抗宿主病，8%为 3-4 级，BMI 正常组中为 14%为 3-4 级急性移植物抗宿主病（p=0.11）。BMI 较高组中 17%的患者发生慢性移植物抗宿主病，BMI 正常组中 30%的患者发生慢性移植物抗宿主病（p=0.09）。然而，BMI 较高和肥胖患者在移植后第一年的感染率和住院天数更多，但重症监护病房（ICU）入住率没有差异。本研究表明，BMI 较高和肥胖并不影响血液系统恶性肿瘤患者接受同种异体移植后的 OS 或 PFS，但会显著影响 BMI 较高和肥胖患者的感染率和住院率。我们建议不应将 BMI 较高的患者排除在同种异体移植之外；然而，应该根据合并症指数进行良好的支持性护理和仔细的患者选择，以避免因感染率增加而带来的风险。
