Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
Jpn J Clin Oncol. 2020 Aug 4;50(8):889-896. doi: 10.1093/jjco/hyaa053.
The relationship between body mass index and overall survival has been controversial in patients who suffered from hematological malignancies and underwent hematopoietic stem cell transplantation.
We collected the data of 686 acute leukemia patients who received only one allogeneic hematopoietic stem cell transplantation in our center from 2008 to 2017. Patients were divided into four groups (underweight, normal weight, overweight and obesity) according to their body mass index pre-hematopoietic stem cell transplantation.
56.4% of patients had normal body mass indices, 17.3% were underweight, 20.4% were overweight and 5.8% were with obesity. Concerning long-term follow-up, the probability of overall survival was significantly lower in overweight (P = 0.010) and patients with obesity (P = 0.065) as compared with normal weight patients, and no statistically significant difference between underweight and normal weight individuals (P = 0.810). The results demonstrated that higher body mass index was associated with poorer overall survival (hazard ratio: 1.79; 95% confidence interval: 1.33-2.40, P < 0.001) and shorter leukemia-free survival (hazard ratio: 1.78; 95% confidence interval: 1.35-2.34, P < 0.001). Additionally, patients exhibiting a higher body mass index were more likely to face the problem of relapse (30.6 vs 20.9%, P < 0.001). Furthermore, non-relapse mortality of patients with obesity was statistically higher than normal weight patients (22.5 vs 9.6%, P = 0.027). Besides, individuals with a higher abdominal girth had shorter survival (hazard ratio: 1.73; 95% confidence interval: 1.29-2.31, P < 0.001) and higher relapse rate (hazard ratio: 1.78; 95% confidence interval: 1.29-2.45, P = 0.001) as compared with those with a lower abdominal girth.
Our results indicate that obesity at pre-hematopoietic stem cell transplantation stage, whether characterized by higher body mass index or abdominal girth, is correlated with poorer outcome.
体质量指数与总生存之间的关系在接受造血干细胞移植的血液恶性肿瘤患者中存在争议。
我们收集了 2008 年至 2017 年期间在我们中心接受单次异基因造血干细胞移植的 686 例急性白血病患者的数据。根据移植前体质量指数，患者被分为 4 组（体重不足、正常体重、超重和肥胖）。
56.4%的患者体质量指数正常，17.3%体重不足，20.4%超重，5.8%肥胖。在长期随访中，超重（P=0.010）和肥胖患者（P=0.065）的总生存率明显低于正常体重患者，而体重不足和正常体重患者之间无统计学差异（P=0.810）。结果表明，较高的体质量指数与较差的总生存率（危险比：1.79；95%置信区间：1.33-2.40，P<0.001）和较短的无白血病生存率（危险比：1.78；95%置信区间：1.35-2.34，P<0.001）相关。此外，体质量指数较高的患者更容易发生复发（30.6%比 20.9%，P<0.001）。此外，肥胖患者的非复发死亡率明显高于正常体重患者（22.5%比 9.6%，P=0.027）。此外，腰围较大的患者生存时间更短（危险比：1.73；95%置信区间：1.29-2.31，P<0.001），复发率更高（危险比：1.78；95%置信区间：1.29-2.45，P=0.001）。
我们的结果表明，造血干细胞移植前阶段的肥胖，无论是表现为较高的体质量指数还是腰围，都与较差的预后相关。
