Effect of obesity on outcomes after autologous hematopoietic stem cell transplantation for multiple myeloma.
Effect of obesity on outcomes after autologous hematopoietic stem cell transplantation for multiple myeloma.
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DOI：
10.1016/j.bbmt.2011.05.005
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发表时间：
2011-12
期刊：
影响因子：
--
通讯作者：
Hari P
中科院分区：
文献类型：
--
作者：
Vogl DT;Wang T;Pérez WS;Stadtmauer EA;Heitjan DF;Lazarus HM;Kyle RA;Kamble R;Weisdorf D;Roy V;Gibson J;Ballen K;Holmberg L;Bashey A;McCarthy PL;Freytes C;Maharaj D;Maiolino A;Vesole D;Hari P
肥胖对化疗剂量和治疗患者的选择有影响。自体造血干细胞移植（AutoHCT）改善多发性骨髓瘤患者的预后，但肥胖患者的最佳化疗剂量尚不明确。我们分析了1995年至2003年间向CIBMTR报告的1087例骨髓瘤AutoHCT接受者接受高剂量美法兰调节，伴或不伴全身照射（TBI）的结果。我们根据身体质量指数（BMI）将患者分为正常、超重、肥胖或严重肥胖。BMI对无进展生存期（PFS）、总生存期（OS）、进展期或非复发死亡率（NRM）没有总体影响。在接受美法兰和TBI调理的患者中，肥胖和严重肥胖患者的PFS和OS优于正常和超重患者，但这一发现的临床意义尚不清楚。更多的肥胖患者更有可能接受减少剂量的美法仑，但没有证据表明美法仑或TBI剂量的变异性影响PFS。因此，目前常用的给药策略melphalan不会影响肥胖患者的预后，肥胖不应排除患者考虑自体移植。需要进一步的研究来优化肥胖患者化疗和放疗的剂量。
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 receiving 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 non-relapse 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.
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作者：
Du Bois, D;Du Bois, EF
通讯作者：
Du Bois, EF
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