Obesity is correlated with poor outcome after allogeneic hematopoietic stem cell transplantation in patients with acute leukemia
Obesity is correlated with poor outcome after allogeneic hematopoietic stem cell transplantation in patients with acute leukemia
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肥胖与急性白血病患者异基因造血干细胞移植后的不良预后相关
DOI：
10.1093/jjco/hyaa053
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发表时间：
2020-08-01
影响因子：
2.4
通讯作者：
Huang, He
中科院分区：
文献类型：
--
作者：
Yu, Jian;Lin, Shangnao;Huang, He
目的：在接受造血干细胞移植的恶性血液病患者中，体重指数与总生存期之间的关系一直存在争议。方法：收集2008-2017年间我科仅接受一次异基因造血干细胞移植的686例急性白血病患者的资料。结果：56.4%的患者体重指数正常，17.3%的患者体重不足，20.4%的患者超重，5.8%的患者肥胖。在长期随访方面，超重(P=0.010)和肥胖(P=0.065)患者的总体生存概率显著低于正常体重患者，而体重不足和正常体重患者之间的总体生存概率差异无统计学意义(P=0.810)。结果显示，体重指数越高，总体生存越差(危险比：1.79，95%可信区间：1.33-2.4，P&0.001)，无白血病生存期越短(危险比：1.78，95%可信区间：1.35-2.34，P<；0.001)。此外，体重指数越高的患者更有可能面临复发问题(30.6%比20.9%，P<；0.001)。肥胖组的无复发死亡率显著高于正常体重组(22.5vs9.6%，P=0.027)。此外，与腹围较低的个体相比，腹围较高的个体生存时间较短(风险比：1.73，95%可信区间：1.29~2.31，P<；0.001)，复发率较高(风险比：1.78，95%可信区间：1.29~2.45，P=0.001)。结论：我们的结果表明，无论是以较高的体重指数或腹围为特征，造血干细胞移植前阶段的肥胖与较差的预后相关。
Objective: 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.Methods: 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.Results: 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.Conclusion: 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.