Impact of Obesity on Clinical Outcomes of Elderly Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myeloid Malignancies.

Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) is a high-risk treatment option for patients with hematologic malignancies. Advanced age and obesity can impact outcomes after allo-HCT. Previous registry studies of all age groups found that obesity does not affect outcomes. However, obesity can accelerate age-related decline in physical function and exacerbate comorbid conditions in older patients. Studies evaluating the effect of obesity on elderly patients undergoing allo-HCT are lacking. We performed a retrospective analysis of 86 nonobese (body mass index [BMI] <30) and obese (BMI ≥30) patients age ≥60 years who underwent allo-HCT for myeloid malignancies between January 2010 and June 2015. We found no significant between-group differences in mean age, sex, comorbid conditions, cytogenetic risk, disease indication for transplantation, or donor type. The median overall survival (OS) was 36 months for the BMI <30 group and 24 months for the BMI ≥30 group (P\u202f=\u202f.55). The median progression-free survival (PFS) was 10.1 months in the BMI <30 group and 13.6 months in the BMI ≥30 group (P\u202f=\u202f.93). There were no significant between-group differences in acute graft-versus-host disease (GVHD) and cumulative incidence of chronic GVHD at 1 year post-transplantation. Among patients admitted for transplantation, the mean length of stay was 25 days in the BMI <30 group and 26 days in the BMI ≥30 group (P\u202f=\u202f.64). The rate of readmission within 30 days of discharge was significantly higher in the BMI ≥30 group (34% versus 16%; P\u202f=\u202f.045). Our data reveal that in these elderly patients with myeloid malignancies undergoing allo-HCT, clinical outcomes, including OS, PFS, and GVHD, were not affected by obesity. Thus, in elderly patients, obesity should not preclude consideration for curative allo-HCT and does not portend worse outcomes after allo-HCT.