Abstract
Autologous hematopoietic stem cell transplantation (auto-HSCT) provides a potentially curative treatment option for relapsed and refractory lymphomas. Obesity displays an emerging epidemic risk factor for global mortality and is associated with an increased mortality in cancer patients. To date, the impact of obesity on the outcome of lymphoma patients undergoing auto-HSCT is understudied. We conducted a retrospective single-center study assessing 119 lymphoma patients who underwent auto-HSCT. Overall survival (OS) served as the primary endpoint whereas progression free survival (PFS), cumulative incidence of non-relapse related mortality (NRM) and cumulative incidence of relapse were analyzed as secondary endpoints. Obese patients (Body mass index, BMI≥30) had significantly lower OS (45.3% vs. 77.9%; p = 0.005) and PFS (29.8% vs. 67.2%; p<0.001) compared to non-obese patients at 48 months post-transplantation. The cumulative incidence of NRM displayed no significant differences while the cumulative incidence of relapse was significantly increased in patients with BMI≥30 (66.2% vs. 21.5%; p<0.001). Patients with a BMI<25 and overweight patients (BMI 25–30; 76.1% vs. 80.9%; p = 0.585), showed no significant difference in OS, whereas patients with BMI≥30 exhibited significant lower OS when compared to either of both groups (76.1% vs. 45.3%; p = .0.021 and 80.9% vs. 45.3%; p = 0.010). Furthermore, in a multivariate analysis, obesity was identified as an independent risk factor for death (Hazard ratio 2.231; 95% CI 1.024 to 4.860; p = 0.043). Further studies are needed to evaluate the reasons for the higher relapse rate causing higher mortality in obese patients.
Highlights
Lymphomas represent a heterogenous group of hematological malignancies with diverse phenotypic and molecular features that influence response to therapy and outcome
According to the recommendations of the Center of Disease Control (CDC) a positive culture bottle was defined as blood stream infection (BSI) but if blood cultures were positive for coagulase-negative staphylococci, two consecutive positive cultures were required to define a BSI[19]
Patients with a body mass index (BMI)
Summary
Lymphomas represent a heterogenous group of hematological malignancies with diverse phenotypic and molecular features that influence response to therapy and outcome. Obesity impairs survival in lymphoma patients subsequent autologous hematopoietic stem cell transplantation (auto-HSCT) with prior highdose chemotherapy (HDT) provides a potentially curative treatment approach in physiologically fit patients with chemosensitive lymphoma and is the recommended treatment for relapsed high-risk lymphoma patients[3,4,5,6]. Previous studies assessed the outcome of HDT and auto-HSCT in overweight lymphoma patients. These studies reached different conclusions concerning survival and onset of relapse[17, 18]. Conclusive data concerning the clinical outcome of obese lymphoma patients receiving HDT followed by auto-HSCT is lacking. We conducted a retrospective single-center study on 119 lymphoma patients, who were treated with HDT and auto-HSCT to evaluate the impact of obesity on patients’ outcomes
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