Division of Pediatric Hematology and Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, USA.
Pediatr Transplant. 2020 Nov;24(7):e13844. doi: 10.1111/petr.13844. Epub 2020 Sep 30.
Pediatric recipients of HCT may have a high susceptibility for overweight and obesity, and obesity may negatively impact post-transplant mortality and survival. This is a single-center retrospective analysis of 297 pediatric patients who received HCT between 2005 and 2018. Patients were classified as UW, NW, OW, or OB based on age-adjusted BMI. A mixed-effects linear regression model controlling for patient, disease, and transplant-related characteristics was used to trend weight longitudinally. Comparisons were made between weight category and post-transplant outcomes. In the pretransplant period, 5.4%, 54.5%, 22.2%, and 17.8% of patients were UW, NW, OW, and OB, respectively. Five years post-transplantation, those numbers were 10.6%, 48.2%, 16.5%, and 24.7%. Overall, BMI increased 0.00094 ± 0.0001 kg/m each day post-transplant (P < .001), with older individuals demonstrating greater rates of increase. Further, there was a larger BMI increase in patients without TBI compared with those who received TBI (1.29 ± 0.49, P = .008). Rates of acute GVHD, chronic GVHD, and viral infections, in addition to time to platelet and neutrophil engraftment and 5-year survival estimates, were not significantly different based on pretransplant BMI. Overweight and obese individuals had poorer 5-year survival based on 100-day post-transplant BMI (P = .02). Overall, pediatric HCT recipients are at risk of developing obesity, which is associated with decreased survival. Adolescents and young adults demonstrate the highest risk of weight gain, representing a vulnerable population that requires close monitoring, additional interventions, and further research.
儿科造血干细胞移植（HCT）受者超重和肥胖的易感性较高，肥胖可能对移植后死亡率和存活率产生负面影响。这是一项对 2005 年至 2018 年间接受 HCT 的 297 名儿科患者的单中心回顾性分析。患者根据年龄调整后的 BMI 分为 UW、NW、OW 或 OB。采用控制患者、疾病和移植相关特征的混合效应线性回归模型对体重进行纵向趋势分析。比较了体重类别与移植后结局的关系。在移植前，分别有 5.4%、54.5%、22.2%和 17.8%的患者为 UW、NW、OW 和 OB。移植后 5 年，这些数字分别为 10.6%、48.2%、16.5%和 24.7%。总体而言，移植后每天 BMI 增加 0.00094±0.0001kg/m（P<.001），年龄较大的个体增长速度更快。此外，未接受颅脑照射（TBI）的患者 BMI 增加幅度大于接受 TBI 的患者（1.29±0.49，P=.008）。基于移植前 BMI，急性移植物抗宿主病、慢性移植物抗宿主病、病毒感染、血小板和中性粒细胞植入时间以及 5 年生存率的发生率并无显著差异。基于移植后 100 天的 BMI，超重和肥胖患者的 5 年生存率较差（P=.02）。总体而言，儿科造血干细胞移植受者有发生肥胖的风险，而肥胖与生存率降低相关。青少年和年轻成人的体重增加风险最高，他们是一个脆弱的群体，需要密切监测、额外的干预措施和进一步的研究。
