Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation

Claudio G. Brunstein, Marcelo C. Pasquini, Soyoung Kim, Mingwei Fei, Kehinde Adekola, Ibrahim Ahmed, Mahmoud Aljurf, Vaibhav Agrawal, Jeffrey J. Auletta, Minoo Battiwalla, Nelli Bejanyan, Joseph Bubalo, Jan Cerny, Lynette Chee, Stefan O. Ciurea, Cesar Freytes, Shahinaz M. Gadalla, Robert Peter Gale, Siddhartha Ganguly, Shahrukh K. HashmiPeiman Hematti, Gerhard Hildebrandt, Leona A. Holmberg, Oscar B. Lahoud, Heather Landau, Hillard M. Lazarus, Marcos de Lima, Vikram Mathews, Richard Maziarz, Taiga Nishihori, Maxim Norkin, Richard Olsson, Ran Reshef, Seth Rotz, Bipin Savani, Harry C. Schouten, Sachiko Seo, Baldeep M. Wirk, Jean Yared, Shin Mineishi, John Rogosheske, Miguel Angel Perales

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Data are limited on whether to adjust high-dose chemotherapy before autologous hematopoietic cell transplant (autoHCT) in obese patients. This study explores the effects of dose adjustment on the outcomes of obese patients, defined as body mass index (BMI) ≥ 30 kg/m 2 . Dose adjustment was defined as a reduction in standard dosing ≥20%, based on ideal, reported dosing and actual weights. We included 2 groups of US patients who had received autoHCT between 2008 and 2014. Specifically, we included patients with multiple myeloma (MM, n = 1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (n = 781) who received carmustine, etoposide, cytarabine, and melphalan conditioning. Chemotherapy dose was adjusted in 1324 patients (78%) with MM and 608 patients (78%) with lymphoma. Age, sex, BMI, race, performance score, comorbidity index, and disease features (stage at diagnosis, disease status, and time to transplant) were similar between dose groups. In multivariate analyses for MM, adjusting for melphalan dose and for center effect had no impact on overall survival (P =.894) and treatment-related mortality (TRM) (P =.62), progression (P =.12), and progression-free survival (PFS; P =.178). In multivariate analyses for lymphoma, adjusting chemotherapy doses did not affect survival (P =.176), TRM (P =.802), relapse (P =.633), or PFS (P =.812). No center effect was observed in lymphoma. This study demonstrates that adjusting chemotherapy dose before autoHCT in obese patients with MM and lymphoma does not influence mortality. These results do not support adjusting chemotherapy dose in this population.

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number3
DOIs
StatePublished - Mar 2019

Keywords

  • Autologous hematopoietic cell transplantation
  • Conditioning regimen
  • Obesity

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Brunstein, C. G., Pasquini, M. C., Kim, S., Fei, M., Adekola, K., Ahmed, I., Aljurf, M., Agrawal, V., Auletta, J. J., Battiwalla, M., Bejanyan, N., Bubalo, J., Cerny, J., Chee, L., Ciurea, S. O., Freytes, C., Gadalla, S. M., Gale, R. P., Ganguly, S., ... Perales, M. A. (2019). Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation. Biology of Blood and Marrow Transplantation, 25(3), 480-487. https://doi.org/10.1016/j.bbmt.2018.11.005