Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Allografting

Impact of being overweight on outcomes of hematopoietic SCT: a meta-analysis

Bone Marrow Transplantation volume 49, pages 66–72 (2014)Cite this article

Subjects

Abstract

The impact of being overweight on outcome after hematopoietic SCT (HSCT) is controversial. We performed meta-analyses to evaluate the impact of being overweight on acute graft-versus-host disease (aGVHD) risk and survival. Original data were obtained from MEDLINE, and studies that evaluated being overweight before transplantation in recipients as a risk factor for aGVHD or a prognostic factor for overall survival (OS) were extracted. Study-specific relative risks on the log scale comparing overweight with non-overweight patients were used to obtain a pooled RR with 95% confidence interval (CI). We identified 8 studies of aGVHD and 21 of OS. In allogeneic HSCT, the meta-analysis determined statistically significant associations of overweight recipients with aGVHD risk and OS. Meta-analysis of the 8 studies of aGVHD indicated that the RR for overweight to non-overweight patients was 1.186 (95% CI: 1.072–1.312). Regarding OS, meta-analysis of 11 allogeneic HSCT studies indicated that the RR for overweight to non-overweight patients was 1.163 (1.009–1.340). Our results indicate that being overweight before transplantation in recipients is associated with a high aGVHD rate and worse survival after allogeneic HSCT. Potential heterogeneity especially in adult/pediatric patients limits the interpretability of our finding. Further, well-designed large cohort studies are warranted.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011; 364: 719–729.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Abelson P, Kennedy D . The obesity epidemic. Science 2004; 304: 1413.

    Article  CAS  PubMed  Google Scholar 

  3. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH . The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 9: 88.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tsugane S, Inoue M . Insulin resistance and cancer: epidemiological evidence. Cancer Sci 2010; 101: 1073–1079.

    Article  CAS  PubMed  Google Scholar 

  5. Nakao M, Hosono S, Ito H, Watanabe M, Mizuno N, Yatabe Y et al. Interaction between IGF-1 polymorphisms and overweight for the risk of pancreatic cancer in Japanese. Int J Mol Epidemiol Genet 2011; 2: 354–366.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Vogl DT, Wang T, Perez WS, Stadtmauer EA, Heitjan DF, Lazarus HM et al. Effect of obesity on outcomes after autologous hematopoietic stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 2011; 17: 1765–1774.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nikolousis E, Nagra S, Paneesha S, Delgado J, Holder K, Bratby L et al. Allogeneic transplant outcomes are not affected by body mass index (BMI) in patients with haematological malignancies. Ann Hematol 2010; 89: 1141–1145.

    Article  PubMed  Google Scholar 

  8. Weiss BM, Vogl DT, Berger NA, Stadtmauer EA, Lazarus HM . Trimming the fat: obesity and hematopoietic cell transplantation. Bone Marrow Transplant, (e-pub ahead of print 29 October 2012; doi:10.1038/bmt.2012.201).

    Article  PubMed  Google Scholar 

  9. Barker CC, Agovi MA, Logan B, Lazarus HM, Ballen KK, Gupta V et al. Childhood obesity and outcomes after bone marrow transplantation for patients with severe aplastic anemia. Biol Blood Marrow Transplant 2011; 17: 737–744.

    Article  PubMed  Google Scholar 

  10. Higgins JP, Thompson SG, Deeks JJ, Altman DG . Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Begg CB, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–1101.

    Article  CAS  PubMed  Google Scholar 

  12. Egger M, Davey Smith G, Schneider M, Minder C . Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sharp S . Metaanalysis regression. Stata Tech Bull 1998; 42: 16–24.

    Google Scholar 

  14. Le Blanc K, Ringden O, Remberger M . A low body mass index is correlated with poor survival after allogeneic stem cell transplantation. Haematologica 2003; 88: 1044–1052.

    PubMed  Google Scholar 

  15. Fuji S, Kim SW, Yoshimura K, Akiyama H, Okamoto S, Sao H et al. Possible association between obesity and posttransplantation complications including infectious diseases and acute graft-versus-host disease. Biol Blood Marrow Transplant 2009; 15: 73–82.

    Article  PubMed  Google Scholar 

  16. Hadjibabaie M, Tabeefar H, Alimoghaddam K, Iravani M, Eslami K, Honarmand H et al. The relationship between body mass index and outcomes in leukemic patients undergoing allogeneic hematopoietic stem cell transplantation. Clinical Transplant 2012; 26: 149–155.

    Article  Google Scholar 

  17. Navarro WH, Agovi MA, Logan BR, Ballen K, Bolwell BJ, Frangoul H et al. Obesity does not preclude safe and effective myeloablative hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) in adults. Biol Blood Marrow Transplant 2010; 16: 1442–1450.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pine M, Wang L, Harrell FE Jr., Calder C, Manes B, Evans M et al. The effect of obesity on outcome of unrelated cord blood transplant in children with malignant diseases. Bone Marrow Transplant 2011; 46: 1309–1313.

    Article  CAS  PubMed  Google Scholar 

  19. Deeg HJ, Seidel K, Bruemmer B, Pepe MS, Appelbaum FR . Impact of patient weight on non-relapse mortality after marrow transplantation. Bone Marrow Transplant 1995; 15: 461–468.

    CAS  PubMed  Google Scholar 

  20. Navarro WH, Loberiza FR Jr., Bajorunaite R, van Besien K, Vose JM, Lazarus HM et al. Effect of body mass index on mortality of patients with lymphoma undergoing autologous hematopoietic cell transplantation. Biol Blood Marrow Transplant 2006; 12: 541–551.

    Article  PubMed  Google Scholar 

  21. Navarro WH . Impact of obesity in the setting of high-dose chemotherapy. Bone Marrow Transplant 2003; 31: 961–966.

    Article  CAS  PubMed  Google Scholar 

  22. Bulley S, Gassas A, Dupuis LL, Aplenc R, Beyene J, Greenberg ML et al. Inferior outcomes for overweight children undergoing allogeneic stem cell transplantation. Br J Haematol 2008; 140: 214–217.

    PubMed  Google Scholar 

  23. Fleming DR, Rayens MK, Garrison J . Impact of obesity on allogeneic stem cell transplant patients: a matched case-controlled study. Am J Med 1997; 102: 265–268.

    Article  CAS  PubMed  Google Scholar 

  24. Hansen JA, Gooley TA, Martin PJ, Appelbaum F, Chauncey TR, Clift RA et al. Bone marrow transplants from unrelated donors for patients with chronic myeloid leukemia. N Engl J Med 1998; 338: 962–968.

    Article  CAS  PubMed  Google Scholar 

  25. Meloni G, Proia A, Capria S, Romano A, Trape G, Trisolini SM et al. Obesity and autologous stem cell transplantation in acute myeloid leukemia. Bone Marrow Transplant 2001; 28: 365–367.

    Article  CAS  PubMed  Google Scholar 

  26. Tarella C, Caracciolo D, Gavarotti P, Argentino C, Zallio F, Corradini P et al. Overweight as an adverse prognostic factor for non-Hodgkin’s lymphoma patients receiving high-dose chemotherapy and autograft. Bone Marrow Transplant 2000; 26: 1185–1191.

    Article  CAS  PubMed  Google Scholar 

  27. Sucak GT, Suyani E, Baysal NA, Altindal S, Cakar MK, Aki SZ et al. The role of body mass index and other body composition parameters in early post-transplant complications in patients undergoing allogeneic stem cell transplantation with busulfan-cyclophosphamide conditioning. Int J Hematol 2012; 95: 95–101.

    Article  CAS  PubMed  Google Scholar 

  28. White M, Murphy AJ, Hallahan A, Ware RS, Fraser C, Davies PS . Survival in overweight and underweight children undergoing hematopoietic stem cell transplantation. Eur J Clin Nutr 2012; 66: 1120–1123.

    Article  CAS  PubMed  Google Scholar 

  29. Singhal S, Gordon LI, Tallman MS, Winter JN, Evens AM, Frankfurt O et al. Ideal rather than actual body weight should be used to calculate cell dose in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2006; 37: 553–557.

    Article  CAS  PubMed  Google Scholar 

  30. Hasenkrug KJ . The leptin connection: regulatory T cells and autoimmunity. Immunity 2007; 26: 143–145.

    Article  CAS  PubMed  Google Scholar 

  31. De Rosa V, Procaccini C, Cali G, Pirozzi G, Fontana S, Zappacosta S et al. A key role of leptin in the control of regulatory T cell proliferation. Immunity 2007; 26: 241–255.

    Article  CAS  PubMed  Google Scholar 

  32. Kawase T, Morishima Y, Matsuo K, Kashiwase K, Inoko H, Saji H et al. High-risk HLA allele mismatch combinations responsible for severe acute graft-versus-host disease and implication for its molecular mechanism. Blood 2007; 110: 2235–2241.

    Article  CAS  PubMed  Google Scholar 

  33. Flegal KM, Graubard BI, Williamson DF, Gail MH . Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298: 2028–2037.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Research on Allergic Disease and Immunology (Health and Labor Science Research Grant H23-010), the Ministry of Health, Labor, and Welfare of Japan.

Author information

Authors and Affiliations

  1. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Japan

    M Nakao, D Chihara, H Tanaka & Y Morishima

  2. Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Japan

    M Nakao & A Niimi

  3. Department of Tumor Immunology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan

    R Ueda

  4. Department of Epidemiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Japan

    H Tanaka

  5. Department of Preventive Medicine, Kyushu University Faculty of Medical Science, 3-1-1 Maidashi, Higashi-ku, Japan

    K Matsuo

Authors
  1. M Nakao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Chihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Niimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y Morishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K Matsuo.

Ethics declarations

Competing interests

The authors declare no conflicts of interest.

Additional information

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nakao, M., Chihara, D., Niimi, A. et al. Impact of being overweight on outcomes of hematopoietic SCT: a meta-analysis. Bone Marrow Transplant 49, 66–72 (2014). https://doi.org/10.1038/bmt.2013.128

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2013.128

Keywords

This article is cited by

Search

Advanced search

Quick links