Al-Ola A Abdallah: How BMI Affects Outcomes After Allogeneic Hematopoietic Stem Cell Transplant for AL and MDS
Al-Ola A Abdallah, Associate Professor and Plasma Cell Disorder Program Director of the Division of HMCT at the University of Kansas Medical Center, shared a post on X: about recent paper by Moazzam Shahzad et al., published on Bone Marrow Transplantation.
“Impact of BMI on Outcomes After Allo-HCT By Muhammad Umair Mushtaq.
A large study (N=7,545) from the CIBMTR registry (2013–2018) looked at how BMI affects outcomes after allogeneic hematopoietic stem cell transplant for AL and MDS.
Let’s break it down.
Key Takeaway: BMI is NOT independently associated with overall survival (OS), relapse, or GVHD.
Higher BMI = modestly faster engraftment (1–3 days). But: Limited clinical significance.
Survival Outcomes:
- BMI had no independent impact on OS.
- Interestingly, overweight patients (BMI 25–29.9) had marginally inferior OS (HR 1.13), but trends were inconsistent.
- Authors urge caution interpreting this.
Disease-Free Survival (DFS) and Relapse: Univariate analysis showed differences. BUT: All associations disappeared after adjusting for confounders. BMI is not a predictor of DFS or relapse risk in multivariate models.
Non-Relapse Mortality (NRM):
- Initially higher in BMI ≥35 group.
- But again, not significant after adjustment.
Takeaway: BMI alone doesn’t predict NRM risk after allo-HCT.
Graft-vs-Host Disease (GVHD):
No link between BMI and acute GVHD. Chronic GVHD risk increased in higher BMI in univariate data—but disappeared in multivariate analysis. BMI is not an independent GVHD driver.
Engraftment:
- Higher BMI is associated with faster neutrophil and platelet engraftment.
- Approximately 1 day faster for neutrophils, around 3 days for platelets.
- Clinically modest: ‘Limited significance.’
Methods in Brief:
- Data: CIBMTR 2013–2018
- Patients: 7,545 adults/peds undergoing allo-HCT
- Endpoints: OS, DFS, relapse, NRM, GVHD, engraftment
- BMI Groups: <18.5 to ≥35 kg/m²
- Stats: Uni- and multivariate Cox models
Limitations:
- Lack of chemo dosing/comorbidities data
- Predominantly White cohort → limited generalizability
- Center-specific practices may skew earlier findings
Bottom Line for Clinicians:
- BMI shouldn’t preclude eligible patients from allo-HCT.
- No strong evidence BMI affects OS, relapse, or GVHD.
- Minor engraftment speed advantage in higher BMI—but not game-changing.
Optimize recovery, but don’t overemphasize BMI.”
Title: Impact of body mass index on outcomes following allogeneic hematopoietic stem cell transplantation
Authors: Moazzam Shahzad, Aleenah Mohsin, Ibrahim Khamees, Aqeeb Ur Rehman, Muhammad Kashif Amin, Sibgha Gull Chaudhary, Iqra Anwer, Kayla Pfannenstiel, Al-Ola Abdallah, Mehdi Hamadani, Joseph P. Mcguirk, Muhammad Umair Mushtaq
Read The Full Article at Bone Marrow Transplantation.
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