Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Biol Blood Marrow Transplant. 2013 Jul;19(7):1081-6. doi: 10.1016/j.bbmt.2013.04.017. Epub 2013 Apr 25.
Although nutritional status may adversely affect various health outcomes, the relationship between anthropometry and outcomes after hematopoietic cell transplantation (HCT) has not been fully studied in children. We analyzed the impact of pre-HCT body mass index (BMI), arm muscle area, and arm fat area on outcomes in 733 patients age 2-18 years who underwent allogeneic HCT for a hematologic malignancy between 1985 and 2009. We evaluated these 3 variables according to patient group based on age- and sex-adjusted percentiles for BMI, arm muscle area (<5th, 5th-24th, 25th-94th, and ≥95th), and arm fat area (<25th, 25th-94th, and ≥95th). Cox proportional hazards regression models for event-free survival (EFS), relapse, and nonrelapse mortality (NRM) at 100 days and 3 years after HCT, as well as grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD, were performed using the 3 major variables and adjusted for covariates. BMI was <5th percentile in only 3% of patients and ≥95th percentile in 15% of patients, but outcomes for both groups were similar to those for the BMI 25th-94th percentile group. The BMI 5th-24th percentile group had lower EFS (P = .01) and higher relapse (P = .003) at day +100 post-HCT, but these associations did not hold at 3 years post-HCT. Arm muscle area was <5th percentile in 8% of patients, and arm fat area was <25th percentile in 10%. Analysis of arm muscle area showed that the <5th percentile group had lower EFS and higher NRM and relapse rate at day +100 (P = .002, .04, and .01, respectively) and 3 years (P = .0004, .008, and .01, respectively) post-HCT. Arm fat area <25th percentile was associated with lower EFS at day +100 (hazard ratio, 1.5; P = .05), but not at 3 years post-HCT. Anthropometry variables were not associated with acute or chronic GVHD. In conclusion, arm muscle area <5th percentile appears to be a stronger predictor than BMI of poor outcomes after HCT in children with hematologic malignancies.
尽管营养状况可能会对各种健康结果产生不利影响，但在儿童中，人体测量学与造血细胞移植（HCT）后的结果之间的关系尚未得到充分研究。我们分析了 733 名 2-18 岁接受血液恶性肿瘤异基因 HCT 的患者的预 HCT 体重指数（BMI）、手臂肌肉面积和手臂脂肪面积对结局的影响，这些患者于 1985 年至 2009 年之间进行。我们根据患者年龄和性别调整后的 BMI、手臂肌肉面积（<5th、5th-24th、25th-94th 和≥95th）和手臂脂肪面积（<25th、25th-94th 和≥95th）的百分位数，根据患者组评估了这 3 个变量。使用 3 个主要变量和调整后的协变量，对 100 天和 3 年后无事件生存（EFS）、复发和非复发死亡率（NRM）、2 级-4 级急性移植物抗宿主病（GVHD）和慢性 GVHD 的 Cox 比例风险回归模型进行了分析。仅 3%的患者 BMI<5th 百分位，15%的患者 BMI≥95th 百分位，但这两组的结果与 BMI 25th-94th 百分位组相似。BMI 5th-24th 百分位组在 HCT 后第 100 天的 EFS 较低（P=0.01），复发率较高（P=0.003），但在 3 年后这些相关性不再成立。8%的患者手臂肌肉面积<5th 百分位，10%的患者手臂脂肪面积<25 百分位。手臂肌肉面积分析显示，<5th 百分位组在第 100 天（P=0.002、0.04 和 0.01）和 3 年（P=0.0004、0.008 和 0.01）时 EFS 较低，NRM 和复发率较高。手臂脂肪面积<25 百分位与第 100 天 EFS 较低相关（危险比，1.5；P=0.05），但与 3 年后无关。人体测量学变量与急性或慢性 GVHD 无关。总之，手臂肌肉面积<5th 百分位似乎比 BMI 更能预测儿童血液恶性肿瘤患者 HCT 后的不良结局。
