Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation.
Biol Blood Marrow Transplant
; 25(3): 480-487, 2019 03.
Article
in En
| MEDLINE
| ID: mdl-30423481
ABSTRACT
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, nâ¯=â¯1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (nâ¯=â¯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 (Pâ¯=â¯.894) and treatment-related mortality (TRM) (Pâ¯=â¯.62), progression (Pâ¯=â¯.12), and progression-free survival (PFS; Pâ¯=â¯.178). In multivariate analyses for lymphoma, adjusting chemotherapy doses did not affect survival (Pâ¯=â¯.176), TRM (Pâ¯=â¯.802), relapse (Pâ¯=â¯.633), or PFS (Pâ¯=â¯.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.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hematopoietic Stem Cell Transplantation
/
Transplantation Conditioning
/
Drug Dosage Calculations
/
Antineoplastic Agents
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Obesity
Type of study:
Prognostic_studies
Limits:
Adult
/
Aged
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Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Biol Blood Marrow Transplant
Journal subject:
HEMATOLOGIA
/
TRANSPLANTE
Year:
2019
Type:
Article
Affiliation country:
United States