Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Br J Haematol. 2022 May;197(3):326-338. doi: 10.1111/bjh.18108. Epub 2022 Mar 14.
It is not known whether obesity has a differential effect on allogeneic haematopoietic cell transplantation outcomes with alternative donor types. We report the results of a retrospective registry study examining the effect of obesity [body mass index (BMI) > 30] on outcomes with alternative donors (haploidentical related donor with two or more mismatches and receiving post-transplant cyclophosphamide [haplo] and cord blood (CBU)] versus matched unrelated donor (MUD). Adult patients receiving haematopoietic cell transplantation for haematologic malignancy (2013-2017) (N = 16 182) using MUD (n = 11 801), haplo (n = 2894) and CBU (n = 1487) were included. The primary outcome was non-relapse mortality (NRM). The analysis demonstrated a significant, non-linear interaction between pretransplant BMI and the three donor groups for NRM: NRM risk was significantly higher with CBU compared to haplo at BMI 25-30 [hazard ratio (HR) 1.66-1.71, p < 0.05] and MUD transplants at a BMI of 25-45 (HR, 1.61-3.47, p < 0.05). The results demonstrated that NRM and survival outcomes are worse in overweight and obese transplant recipients (BMI ≥ 25) with one alternative donor type over MUD, although obesity does not appear to confer a uniform differential mortality risk with one donor type over the other. BMI may serve as a criterion for selecting a donor among the three (MUD, haplo and CBU) options, if matched sibling donor is not available.
目前尚不清楚肥胖对不同供者类型的异基因造血细胞移植结局是否有差异影响。我们报告了一项回顾性登记研究的结果，该研究检查了肥胖[体重指数（BMI）>30]对替代供者（两个或更多错配的单倍体相关供者，接受移植后环磷酰胺[单倍体]和脐带血[CBU]）与匹配的无关供者（MUD）的影响。2013-2017 年，接受造血细胞移植治疗血液系统恶性肿瘤的成年患者（N=16182），使用 MUD（n=11801）、单倍体（n=2894）和 CBU（n=1487）。主要结局是非复发死亡率（NRM）。分析显示，NRM 与移植前 BMI 之间存在显著的非线性相互作用，与三种供者群体有关：与单倍体相比，CBU 在 BMI 为 25-30 时[危险比（HR）1.66-1.71，p<0.05]和 MUD 移植时 BMI 为 25-45 时（HR，1.61-3.47，p<0.05），NRM 风险显著更高。结果表明，超重和肥胖移植受者（BMI≥25）的 NRM 和生存结局比 MUD 差，尽管肥胖似乎不会使一种供者类型的死亡率风险比另一种供者类型更均匀。如果没有匹配的同胞供者，BMI 可能成为三种（MUD、单倍体和 CBU）选择中供者的选择标准。
