Introduction
Obesity is an increasing problem in the United States, with one in five
adolescents obese,1 and a leading cause of morbidity
and mortality. The negative consequences of obesity on health has been
well documented in the literature,2,3 prompting
clinical and public health measures for both treatment and
prevention.4 Further, certain individuals, such as
survivors of childhood malignant diseases including acute lymphoblastic
and myeloid leukemias (ALL and AML) have demonstrated increased risk for
obesity5–8 and cardiometabolic
disease9–11 in comparison to their corresponding age
group in the general population. This increased susceptibility for
weight gain has been noted early in treatment, throughout treatment, and
well beyond.12
Hematopoietic cell transplantation (HCT) is a well-established and
widely utilized treatment for a variety of malignant and non-malignant
conditions.13 Efforts to better understand and predict
the impacts of comorbidities on transplant outcomes have led to the
creation of the HCT comorbidity index, which includes obesity as one of
the factors for risk assessment and prediction of nonrelapse mortality
and survival.14 With recent studies demonstrating an
association between obesity and reduced survival in
adult15 and pediatric16 HCT
recipients, the growing interest on body habitus, a potentially
modifiable risk factor, and its effects on HCT outcomes have prompted
research on the converse – the influence of HCT on body mass index
(BMI). Thus far, the literature has demonstrated that pediatric HCT
recipients may experience a reduction in BMI after
transplantation,17 as well as an
increase.18 As the data on the weight status of
children after HCT is limited and inconsistent, further exploration in
this field is needed.
In this study, we sought to characterize the interactions between
pediatric BMI and HCT outcomes at our institution. We have included
longitudinal data during the pre-transplant period up to 5 years
post-transplantation, to investigate the trends in weight status and
outcomes throughout the pre-transplant, immediate post-transplant, and
long-term post-transplant periods.