Does recipient body mass index inform donor selection for allogeneic haematopoietic cell transplantation?

Mouhamed Yazan Abou-Ismail, Raphael Fraser, Mariam Allbee-Johnson, Leland Metheny, Gayathri Ravi, Kwang Woo Ahn, Neel S. Bhatt, Hillard M. Lazarus, Marcos de Lima, Najla El Jurdy, Peiman Hematti, Amer M. Beitinjaneh, Taiga Nishihori, Sherif M. Badawy, Akshay Sharma, Marcelo C. Pasquini, Bipin N. Savani, Mohamed L. Sorror, Edward A. Stadtmauer, Saurabh Chhabra*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

It is not known whether obesity has a differential effect on allogeneic haematopoietic cell transplantation outcomes with alternative donor types. We report the results of a retrospective registry study examining the effect of obesity [body mass index (BMI) > 30] on outcomes with alternative donors (haploidentical related donor with two or more mismatches and receiving post-transplant cyclophosphamide [haplo] and cord blood (CBU)] versus matched unrelated donor (MUD). Adult patients receiving haematopoietic cell transplantation for haematologic malignancy (2013–2017) (N = 16 182) using MUD (n = 11 801), haplo (n = 2894) and CBU (n = 1487) were included. The primary outcome was non-relapse mortality (NRM). The analysis demonstrated a significant, non-linear interaction between pretransplant BMI and the three donor groups for NRM: NRM risk was significantly higher with CBU compared to haplo at BMI 25–30 [hazard ratio (HR) 1.66–1.71, p < 0.05] and MUD transplants at a BMI of 25–45 (HR, 1.61–3.47, p < 0.05). The results demonstrated that NRM and survival outcomes are worse in overweight and obese transplant recipients (BMI ≥ 25) with one alternative donor type over MUD, although obesity does not appear to confer a uniform differential mortality risk with one donor type over the other. BMI may serve as a criterion for selecting a donor among the three (MUD, haplo and CBU) options, if matched sibling donor is not available.

Original languageEnglish (US)
Pages (from-to)326-338
Number of pages13
JournalBritish Journal of Haematology
Volume197
Issue number3
DOIs
StatePublished - May 2022

Keywords

  • allogeneic cell transplant
  • alternative donor types
  • cord blood units
  • haploidentical
  • non-relapse mortality
  • obesity

ASJC Scopus subject areas

  • Hematology

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