Effect of obesity on outcomes after autologous hematopoietic stem cell transplantation for multiple myeloma

Dan T. Vogl, Tao Wang, Waleska S. Pérez, Edward A. Stadtmauer, Daniel F. Heitjan, Hillard M. Lazarus, Robert A. Kyle, Ram Kamble, Daniel Weisdorf, Vivek Roy, John Gibson, Karen Ballen, Leona Holmberg, Asad Bashey, Philip L. McCarthy, Cesar Freytes, Dipnarine Maharaj, Angelo Maiolino, David Vesole, Parameswaran Hari

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Obesity has implications for chemotherapy dosing and selection of patients for therapy. Autologous hematopoietic stem cell transplant (AutoHCT) improves outcomes for patients with multiple myeloma, but optimal chemotherapy dosing for obese patients is poorly defined. We analyzed the outcomes of 1087 recipients of AutoHCT for myeloma reported to the CIBMTR between 1995 and 2003 who received high-dose melphalan conditioning, with or without total body irradiation (TBI). We categorized patients by body mass index (BMI) as normal, overweight, obese, or severely obese. There was no overall effect of BMI on progression-free survival (PFS), overall survival (OS), progression, or nonrelapse mortality (NRM). In patients receiving melphalan and TBI conditioning, obese and severely obese patients had superior PFS and OS compared with normal and overweight patients, but the clinical significance of this finding is unclear. More obese patients were more likely to receive a reduced dose of melphalan, but there was no evidence that melphalan or TBI dosing variability affected PFS. Therefore, current common strategies of dosing melphalan do not impair outcomes for obese patients, and obesity should not exclude patients from consideration of autologous transplantation. Further research is necessary to optimize dosing of both chemotherapy and radiation in obese patients.

Original languageEnglish (US)
Pages (from-to)1765-1774
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2011

Keywords

  • Autologous transplantation
  • Chemotherapy
  • Melphalan
  • Myeloma
  • Obesity
  • Radiation therapy

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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