Effect of body mass in children with hematologic malignancies undergoing allogeneic bone marrow transplantation
Effect of body mass in children with hematologic malignancies undergoing allogeneic bone marrow transplantation
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DOI：
10.1182/blood-2013-03-490334
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发表时间：
2014-05-29
期刊：
影响因子：
20.3
通讯作者：
Bunin, Nancy
中科院分区：
文献类型：
--
作者：
Aplenc, Richard;Zhang, Mei-Jie;Bunin, Nancy
儿童肥胖发生率的上升可能会显着影响骨髓移植（BMT）的结果。我们分析了 1990 年至 2007 年间全球 3687 名接受基于环磷酰胺的白血病 BMT 治疗方案的儿童的结果。根据年龄调整体重指数 (BMI) 百分位数将接受者分类为体重不足 (UW)、有 UW 风险 (RUW)、正常、超重 (OW) 或肥胖 (OB)。所有组中的中位年龄和种族相似。百分之六十一的产科儿童来自美国/加拿大。 BMI 组的三年无复发生存率和总生存率分别为 48% 至 52% (P = .54) 和 55% 至 58% (P = .81)。 UW、RUW、正常、OW 和 OB 组的三年白血病复发率分别为 33%、33%、29%、25% 和 21% (P < .001)。移植相关死亡率 (TRM) 的相应累积发生率为 18%、19%、21%、22% 和 28% (P < .01)。多变量分析表明，与正常 BMI 相比，复发风险降低（相对风险 [RR] = 0.73；P < .01），且 TRM 呈较高趋势（RR = 1.28；P = .014）。儿童 BMI 与血液恶性肿瘤 BMT 后的不同生存率没有显着相关。与体重指数正常的儿童相比，肥胖儿童移植后的复发率较低；然而，这种好处被 TRM 的过剩所抵消。
The rising incidence of pediatric obesity may significantly affect bone marrow transplantation (BMT) outcomes. We analyzed outcomes in 3687 children worldwide who received cyclophosphamide-based BMT regimens for leukemias between 1990 and 2007. Recipients were classified according to age-adjusted body mass index (BMI) percentiles as underweight (UW), at risk of UW (RUW), normal, overweight (OW), or obese (OB). Median ageandrace were similar in all groups. Sixty-one percent of OB children were from the United States/Canada. Three-year relapse-free and overall survival ranged from 48% to 52% (P = .54) and 55% to 58% (P = .81) across BMI groups. Three-year leukemia relapses were 33%, 33%, 29%, 25%, and 21% in the UW, RUW, normal, OW, and OB groups, respectively (P < .001). Corresponding cumulative incidences for transplant-related mortality (TRM) were 18%, 19%, 21%, 22%, and 28% (P < .01). Multivariate analysis demonstrated a decreased risk of relapse compared with normal BMI (relative risk [RR] = 0.73; P < .01) and a trend toward higher TRM (RR = 1.28; P = .014). BMI in children is not significantly associated with different survival after BMT for hematologic malignancies. Obese children experience less relapse posttransplant compared with children with normal BMI; however, this benefit is offset by excess in TRM.