Chen Yao, Xu Lanping, Liu Daihong, Liu Kaiyan, Chen Huan, Zhang Xiaohui, Wang Fengrong, Wang Jingzhi, Wang Yu, Han Wei, Chen Yuhong, Yan Chenhua, Zhao Ting, Huang Xiaojun
Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, People's Hospital, Peking University, Beijing 100044, China.
Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, People's Hospital, Peking University, Beijing 100044, China. Email:
Zhonghua Nei Ke Za Zhi. 2014 Sep;53(9):710-4.
To investigate the impact of body mass index (BMI) before transplantation on clinical outcomes of haploidentical allogeneic stem cell transplantation (allo-HSCT).
We performed a retrospective cohort study of 253 adult patients with acute or chronic leukemia who received haploidentical allo-HSCT from August 2008 to September 2011. All conditioning regimens were myeloablative and bulsufan based. Patients were stratified according to BMI values (low BMI group: <18 kg/m(2); normal BMI group: ≥ 18 and < 25 kg/m(2); overweight BMI group: ≥ 25 kg/m(2)). Other possible risk factors correlated with GVHD, relapse, transplant related mortality (TRM) and overall survival (OS) included age and gender of donor and recipient, HLA disparity, relationship between donor and recipient, diagnosis, status of disease, ATG dose in conditioning regime(10 mg/kg , 6 mg/kg), mononuclear cells (MNC), CD(+)34 and CD(+)3 cell amount from granulocyte colony-stimulating factor (G-CSF) primed bone marrow grafts (G-BM) and G-CSF mobilized peripheral blood grafts(G-PB). Cox regression analysis was used to determine the related risk factors.
The median age of all 253 patients was 31 (18-56) years, including 128 cases with acute myeloid leukemia (AML), 95 cases with acute lymphocytic leukemia (ALL), and 30 cases with chronic myeloid leukemia (CML). According to primary diseases, 185 patients were classified in the standard -risk group and 68 cases in the high-risk group. Median follow-up time was 929 days (range: 48-1762 days) post-transplantation. Engraftment has been attained 252 (99.6%) recipients with the median time of granulocyte and platelet recovery 12 days (ranging from 9 to 45 days) and 16 days (ranging from 7 to 180 days), respectively. Cumulative incidences of acute GVHD was 33.2% with median time of 25 days (range: 13-88 days) after transplant. Multivariate analysis identified that low BMI was associated with an increased risk of grade III-IV acute GVHD (HR = 5.736, 95%CI 1.779-18.491, P = 0.003). There was no significant impact of BMI to other manifestations of GVHD, TRM, relapse or OS in different groups.
Our findings demonstrate a correlation between pre transplant BMI and clinical outcome post-transplant. Low BMI was associated with increased risk of severe acute GVHD in leukemia patients receiving haploidentical allo-HSCT. Meticulous supportive care pre-transplantation is required for low BMI patients.
探讨移植前体重指数（BMI）对单倍体异基因造血干细胞移植（allo-HSCT）临床结局的影响。
我们对2008年8月至2011年9月期间接受单倍体allo-HSCT的253例成年急性或慢性白血病患者进行了一项回顾性队列研究。所有预处理方案均为清髓性且以白消安为基础。患者根据BMI值分层（低BMI组：<18 kg/m²；正常BMI组：≥18且<25 kg/m²；超重BMI组：≥25 kg/m²）。其他与移植物抗宿主病（GVHD）、复发、移植相关死亡率（TRM）和总生存期（OS）相关的可能危险因素包括供者和受者的年龄及性别、HLA不相合程度、供者与受者的关系、诊断、疾病状态、预处理方案中抗胸腺细胞球蛋白（ATG）剂量（10 mg/kg、6 mg/kg）、单个核细胞（MNC）、来自粒细胞集落刺激因子（G-CSF）动员的骨髓移植物（G-BM）和G-CSF动员的外周血移植物（G-PB）中的CD⁺34和CD⁺3细胞数量。采用Cox回归分析确定相关危险因素。
253例患者的中位年龄为31（18 - 56）岁，其中急性髓系白血病（AML）128例，急性淋巴细胞白血病（ALL）95例，慢性髓系白血病（CML）30例。根据原发疾病，185例患者被归类为标准风险组，68例为高风险组。移植后中位随访时间为929天（范围：48 - 1762天）。252例（99.6%）受者实现了造血植入，粒细胞和血小板恢复的中位时间分别为12天（范围：9 - 45天）和16天（范围：7 - 180天）。急性GVHD的累积发生率为33.2%，中位时间为移植后25天（范围：13 - 88天）。多因素分析表明，低BMI与III - IV级急性GVHD风险增加相关（HR = 5.736，95%CI 1.779 - 18.491，P = 0.003）。BMI对不同组中GVHD的其他表现、TRM、复发或OS无显著影响。
我们的研究结果表明移植前BMI与移植后临床结局之间存在相关性。低BMI与接受单倍体allo-HSCT的白血病患者发生严重急性GVHD的风险增加相关。低BMI患者移植前需要细致的支持性护理。
