Effect of conditioning regimen dose reduction in obese patients undergoing autologous hematopoietic cell transplantation Journal Article


Authors: 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.; Hashmi, S. K.; Hematti, P.; Hildebrandt, G.; Holmberg, L. A.; Lahoud, O. B.; Landau, H.; Lazarus, H. M.; de Lima, M.; Mathews, V.; Maziarz, R.; Nishihori, T.; Norkin, M.; Olsson, R.; Reshef, R.; Rotz, S.; Savani, B.; Schouten, H. C.; Seo, S.; Wirk, B. M.; Yared, J.; Mineishi, S.; Rogosheske, J.; Perales, M. A.
Article Title: Effect of conditioning regimen dose reduction in obese patients undergoing autologous hematopoietic cell transplantation
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. © 2018 American Society for Blood and Marrow Transplantation
Keywords: adult; cancer survival; controlled study; aged; major clinical study; overall survival; cancer recurrence; cancer combination chemotherapy; drug dose reduction; cytarabine; drug megadose; progression free survival; multiple myeloma; etoposide; obesity; melphalan; retrospective study; cancer mortality; carmustine; hodgkin disease; nonhodgkin lymphoma; transplantation conditioning; observational study; disease exacerbation; autologous hematopoietic stem cell transplantation; autologous hematopoietic cell transplantation; conditioning regimen; human; male; female; article; obese patient
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 3
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2019-03-01
Start Page: 480
End Page: 487
Language: English
DOI: 10.1016/j.bbmt.2018.11.005
PUBMED: 30423481
PROVIDER: scopus
PMCID: PMC6445718
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Miguel-Angel Perales
    395 Perales
  2. Heather Jolie Landau
    192 Landau
  3. Oscar Boutros Lahoud
    9 Lahoud