Pediatric Hematopoietic Cell Transplantation: Longitudinal Trends in
Body Mass Index and Outcomes
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.