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Pediatric Hematopoietic Cell Transplantation: Longitudinal Trends in Body Mass Index and Outcomes
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  • Brian Dang,
  • Holly Wilhalme,
  • James Ch'ng,
  • Satiro De Oliveira,
  • Lavette Bowles,
  • Ted Moore
Brian Dang
University of California Los Angeles David Geffen School of Medicine
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Holly Wilhalme
Division of General Internal Medicine and Health Services Research, University of California Los Angeles
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James Ch'ng
University of California Los Angeles David Geffen School of Medicine
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Satiro De Oliveira
University of California
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Lavette Bowles
University of California Los Angeles David Geffen School of Medicine
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Ted Moore
UCLA Medical Center
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Abstract

Background Obesity is an increasing problem in the United States, with one in five adolescents obese. Past studies have shown that pediatric recipients of hematopoietic cell transplants (HCT) may have a higher susceptibility to overweight and obesity. Procedure This is a single-center retrospective analysis of 297 pediatric patients who received HCT between 2005-2018. Patients were divided into four weight categories of underweight (UW), normal weight (NW), overweight (OW), and obese (OB) based on age adjusted body mass index (BMI) conversion scales. Post-transplant outcomes included acute graft vs. host disease (GVHD), chronic graft vs. host disease, viral infection rates, time to platelet and neutrophil engraftment, and overall survival. Results In the pre-transplant period, the percentage of individuals who were UW, NW, OW, and OB were 5.4%, 54.5%, 22.2%, and 17.8% respectively. At the five-year post-transplant mark, those numbers were 10.6%, 48.2%, 16.5%, and 24.7%. Overall, BMI was found to increase 0.00094 ± 0.0001 kg/m2 each day after transplant (p < 0.001), with older individuals demonstrating greater trends of BMI increase. Further, there was a larger BMI increase in those who did not receive TBI compared with those who received TBI (1.29 ± 0.49, p=0.008). The rates of acute graft vs. host disease (GVHD), chronic GVHD, and viral infection, in addition to time to platelet and neutrophil engraftment and 5-year survival estimate, were not significantly different among weight groups. Conclusion Pediatric HCT recipients are at high risk of developing overweight or obesity after transplant.

Peer review status:Published

30 Sep 2020Published in Pediatric Transplantation. 10.1111/petr.13844