Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019 Mar;25(3):480-487
Date
11/14/2018Pubmed ID
30423481Pubmed Central ID
PMC6445718DOI
10.1016/j.bbmt.2018.11.005Scopus ID
2-s2.0-85058228349 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
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/m2. 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.
Author List
Brunstein CG, Pasquini MC, Kim S, Fei M, Adekola K, Ahmed I, Aljurf M, Agrawal V, Auletta JJ, Battiwalla M, Bejanyan N, Bubalo J, Cerny J, Chee L, Ciurea SO, Freytes C, Gadalla SM, Gale RP, Ganguly S, Hashmi SK, Hematti P, Hildebrandt G, Holmberg LA, Lahoud OB, Landau H, Lazarus HM, de Lima M, Mathews V, Maziarz R, Nishihori T, Norkin M, Olsson R, Reshef R, Rotz S, Savani B, Schouten HC, Seo S, Wirk BM, Yared J, Mineishi S, Rogosheske J, Perales MAAuthors
Peiman Hematti MD Professor in the Medicine department at Medical College of WisconsinSoyoung Kim PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Marcelo C. Pasquini MD, MS Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Antineoplastic Agents
Drug Dosage Calculations
Female
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma
Male
Middle Aged
Mortality
Multiple Myeloma
Obesity
Recurrence
Transplantation Conditioning
Transplantation, Autologous