Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation

Claudio G. Brunstein, Marcelo C. Pasquini, Soyoung Kim, Mingwei Fei, Kehinde Adekola, Ibrahim Ahmed, Mahmoud Aljurf, Vaibhav Agrawal, Jeffrey J. Auletta, Minoo Battiwalla, Nelli Bejanyan, Joseph Bubalo, Jan Cerny, Lynette Chee, Stefan O. Ciurea, Cesar Freytes, Shahinaz M. Gadalla, Robert Peter Gale, Siddhartha Ganguly, Shahrukh K. HashmiPeiman Hematti, Gerhard Hildebrandt, Leona A. Holmberg, Oscar B. Lahoud, Heather Landau, Hillard M. Lazarus, Marcos de Lima, Vikram Mathews, Richard Maziarz, Taiga Nishihori, Maxim Norkin, Richard Olsson, Ran Reshef, Seth Rotz, Bipin Savani, Harry C. Schouten, Sachiko Seo, Baldeep Wirk, Jean Yared, Shin Mineishi, John Rogosheske, Miguel Angel Perales

Research output: Contribution to journalArticle

1 Citation (Scopus)

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/m 2 . 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, n = 1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (n = 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 (P =.894) and treatment-related mortality (TRM) (P =.62), progression (P =.12), and progression-free survival (PFS; P =.178). In multivariate analyses for lymphoma, adjusting chemotherapy doses did not affect survival (P =.176), TRM (P =.802), relapse (P =.633), or PFS (P =.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.

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number3
DOIs
StatePublished - Mar 1 2019

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Cell Transplantation
Melphalan
Lymphoma
Drug Therapy
Transplants
Mortality
Body Mass Index
Multivariate Analysis
Carmustine
Survival
Cytarabine
Etoposide
Multiple Myeloma
Hodgkin Disease
Non-Hodgkin's Lymphoma
Disease-Free Survival
Comorbidity
Weights and Measures
Recurrence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Brunstein, Claudio G. ; Pasquini, Marcelo C. ; Kim, Soyoung ; Fei, Mingwei ; Adekola, Kehinde ; Ahmed, Ibrahim ; Aljurf, Mahmoud ; Agrawal, Vaibhav ; Auletta, Jeffrey J. ; Battiwalla, Minoo ; Bejanyan, Nelli ; Bubalo, Joseph ; Cerny, Jan ; Chee, Lynette ; Ciurea, Stefan O. ; Freytes, Cesar ; Gadalla, Shahinaz M. ; Gale, Robert Peter ; Ganguly, Siddhartha ; Hashmi, Shahrukh K. ; Hematti, Peiman ; Hildebrandt, Gerhard ; Holmberg, Leona A. ; Lahoud, Oscar B. ; Landau, Heather ; Lazarus, Hillard M. ; de Lima, Marcos ; Mathews, Vikram ; Maziarz, Richard ; Nishihori, Taiga ; Norkin, Maxim ; Olsson, Richard ; Reshef, Ran ; Rotz, Seth ; Savani, Bipin ; Schouten, Harry C. ; Seo, Sachiko ; Wirk, Baldeep ; Yared, Jean ; Mineishi, Shin ; Rogosheske, John ; Perales, Miguel Angel. / Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation. In: Biology of Blood and Marrow Transplantation. 2019 ; Vol. 25, No. 3. pp. 480-487.
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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/m 2 . 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, n = 1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (n = 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 (P =.894) and treatment-related mortality (TRM) (P =.62), progression (P =.12), and progression-free survival (PFS; P =.178). In multivariate analyses for lymphoma, adjusting chemotherapy doses did not affect survival (P =.176), TRM (P =.802), relapse (P =.633), or PFS (P =.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.",
author = "Brunstein, {Claudio G.} and Pasquini, {Marcelo C.} and Soyoung Kim and Mingwei Fei and Kehinde Adekola and Ibrahim Ahmed and Mahmoud Aljurf and Vaibhav Agrawal and Auletta, {Jeffrey J.} and Minoo Battiwalla and Nelli Bejanyan and Joseph Bubalo and Jan Cerny and Lynette Chee and Ciurea, {Stefan O.} and Cesar Freytes and Gadalla, {Shahinaz M.} and Gale, {Robert Peter} and Siddhartha Ganguly and Hashmi, {Shahrukh K.} and Peiman Hematti and Gerhard Hildebrandt and Holmberg, {Leona A.} and Lahoud, {Oscar B.} and Heather Landau and Lazarus, {Hillard M.} and {de Lima}, Marcos and Vikram Mathews and Richard Maziarz and Taiga Nishihori and Maxim Norkin and Richard Olsson and Ran Reshef and Seth Rotz and Bipin Savani and Schouten, {Harry C.} and Sachiko Seo and Baldeep Wirk and Jean Yared and Shin Mineishi and John Rogosheske and Perales, {Miguel Angel}",
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Brunstein, CG, Pasquini, MC, Kim, S, Fei, M, Adekola, K, Ahmed, I, Aljurf, M, Agrawal, V, Auletta, JJ, Battiwalla, M, Bejanyan, N, Bubalo, J, Cerny, J, Chee, L, Ciurea, SO, Freytes, C, Gadalla, SM, Gale, RP, Ganguly, S, Hashmi, SK, Hematti, P, Hildebrandt, G, Holmberg, LA, Lahoud, OB, Landau, H, Lazarus, HM, de Lima, M, Mathews, V, Maziarz, R, Nishihori, T, Norkin, M, Olsson, R, Reshef, R, Rotz, S, Savani, B, Schouten, HC, Seo, S, Wirk, B, Yared, J, Mineishi, S, Rogosheske, J & Perales, MA 2019, 'Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation', Biology of Blood and Marrow Transplantation, vol. 25, no. 3, pp. 480-487. https://doi.org/10.1016/j.bbmt.2018.11.005

Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation. / Brunstein, Claudio G.; Pasquini, Marcelo C.; Kim, Soyoung; Fei, Mingwei; Adekola, Kehinde; Ahmed, Ibrahim; Aljurf, Mahmoud; Agrawal, Vaibhav; Auletta, Jeffrey J.; Battiwalla, Minoo; Bejanyan, Nelli; Bubalo, Joseph; Cerny, Jan; Chee, Lynette; Ciurea, Stefan O.; Freytes, Cesar; Gadalla, Shahinaz M.; Gale, Robert Peter; Ganguly, Siddhartha; Hashmi, Shahrukh K.; Hematti, Peiman; Hildebrandt, Gerhard; Holmberg, Leona A.; Lahoud, Oscar B.; Landau, Heather; Lazarus, Hillard M.; de Lima, Marcos; Mathews, Vikram; Maziarz, Richard; Nishihori, Taiga; Norkin, Maxim; Olsson, Richard; Reshef, Ran; Rotz, Seth; Savani, Bipin; Schouten, Harry C.; Seo, Sachiko; Wirk, Baldeep; Yared, Jean; Mineishi, Shin; Rogosheske, John; Perales, Miguel Angel.

In: Biology of Blood and Marrow Transplantation, Vol. 25, No. 3, 01.03.2019, p. 480-487.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of Conditioning Regimen Dose Reduction in Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation

AU - Brunstein, Claudio G.

AU - Pasquini, Marcelo C.

AU - Kim, Soyoung

AU - Fei, Mingwei

AU - Adekola, Kehinde

AU - Ahmed, Ibrahim

AU - Aljurf, Mahmoud

AU - Agrawal, Vaibhav

AU - Auletta, Jeffrey J.

AU - Battiwalla, Minoo

AU - Bejanyan, Nelli

AU - Bubalo, Joseph

AU - Cerny, Jan

AU - Chee, Lynette

AU - Ciurea, Stefan O.

AU - Freytes, Cesar

AU - Gadalla, Shahinaz M.

AU - Gale, Robert Peter

AU - Ganguly, Siddhartha

AU - Hashmi, Shahrukh K.

AU - Hematti, Peiman

AU - Hildebrandt, Gerhard

AU - Holmberg, Leona A.

AU - Lahoud, Oscar B.

AU - Landau, Heather

AU - Lazarus, Hillard M.

AU - de Lima, Marcos

AU - Mathews, Vikram

AU - Maziarz, Richard

AU - Nishihori, Taiga

AU - Norkin, Maxim

AU - Olsson, Richard

AU - Reshef, Ran

AU - Rotz, Seth

AU - Savani, Bipin

AU - Schouten, Harry C.

AU - Seo, Sachiko

AU - Wirk, Baldeep

AU - Yared, Jean

AU - Mineishi, Shin

AU - Rogosheske, John

AU - Perales, Miguel Angel

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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/m 2 . 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, n = 1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (n = 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 (P =.894) and treatment-related mortality (TRM) (P =.62), progression (P =.12), and progression-free survival (PFS; P =.178). In multivariate analyses for lymphoma, adjusting chemotherapy doses did not affect survival (P =.176), TRM (P =.802), relapse (P =.633), or PFS (P =.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.

AB - 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/m 2 . 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, n = 1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (n = 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 (P =.894) and treatment-related mortality (TRM) (P =.62), progression (P =.12), and progression-free survival (PFS; P =.178). In multivariate analyses for lymphoma, adjusting chemotherapy doses did not affect survival (P =.176), TRM (P =.802), relapse (P =.633), or PFS (P =.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.

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