Guo Wenwen, Zhang Haixiao, Gao Hongye, Zheng Yawei, Wang Mingyang, Cao Wenbin, Zhang Rongli, Ma Qiaoling, He Yi, Zhai Weihua, Yang Donglin, Pang Aiming, Feng Sizhou, Han Mingzhe, Cao Yigeng, Jiang Erlie
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Front Immunol. 2025 Jul 4;16:1586523. doi: 10.3389/fimmu.2025.1586523. eCollection 2025.
The prognostic significance of body mass index (BMI) in elderly acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) remains controversial.
This retrospective study analyzed 142 AML patients aged ≥50 years receiving allo-HCT (2013-2022), stratified by Chinese BMI criteria: low BMI (<24 kg/m², n = 83) vs. high BMI (≥24 kg/m², n = 59).
The median pre-transplant BMI was 23.63 (IQR, 22.07-25.78) kg/m². Multivariate analysis identified BMI <24 kg/m² as an independent risk factor for inferior OS (HR=1.80, p=0.037) and GRFS (HR=2.00, p = 0.003). Although BMI did not correlate with relapse, long-term non-relapse mortality (NRM), or the incidence of acute and chronic graft versus host disease (GVHD), the one-year NRM was significantly higher in the low BMI group compared to the high BMI group (p = 0.006). Subgroup analysis revealed that high-risk patients [not complete remission (NR) or CR but minimal residual disease (MRD)-positive) with low BMI had markedly reduced 3-year OS (20.87% vs. 57.69%, p=0.006), whereas no difference was observed in low-risk (CR/MRD-negative) patients.
Pre-transplant BMI independently predicts inferior survival in older adults with AML undergoing allo-HCT. These findings highlight the need for BMI-guided nutritional interventions, especially for high-risk older patients.
体重指数（BMI）对接受异基因造血细胞移植（allo-HCT）的老年急性髓系白血病（AML）患者的预后意义仍存在争议。
本回顾性研究分析了142例年龄≥50岁接受allo-HCT的AML患者（2013 - 2022年），根据中国BMI标准分层：低BMI（<24 kg/m²，n = 83）与高BMI（≥24 kg/m²，n = 59）。
移植前BMI中位数为23.63（IQR，22.07 - 25.78）kg/m²。多因素分析确定BMI<24 kg/m²是总生存期（OS）较差（HR = 1.80，p = 0.037）和无复发生存期（GRFS）较差（HR = 2.00，p = 0.003）的独立危险因素。尽管BMI与复发、长期非复发死亡率（NRM）或急性和慢性移植物抗宿主病（GVHD）的发生率无关，但低BMI组1年NRM显著高于高BMI组（p = 0.006）。亚组分析显示，低BMI的高危患者（未完全缓解（NR）或完全缓解（CR）但微小残留病（MRD）阳性）3年OS显著降低（20.87%对57.69%，p = 0.006），而低危（CR/MRD阴性）患者未观察到差异。
移植前BMI独立预测接受allo-HCT的老年AML患者生存期较差。这些发现凸显了以BMI为指导进行营养干预的必要性，尤其是对于高危老年患者。
