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Biol Blood Marrow Transplant. 2018 Apr;24(4):799-805. doi: 10.1016/j.bbmt.2017.12.790. Epub 2017 Dec 27.

Low Body Mass Index Is Associated with Increased Risk of Acute GVHD after Umbilical Cord Blood Transplantation in Children and Young Adults with Acute Leukemia: A Study on Behalf of Eurocord and the EBMT Pediatric Disease Working Party.

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Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco. Electronic address:
Pediatric Hematology Department, Hospital Robert Debré, Paris, Paris 7-Paris Diderot University, Paris, France.
Pediatric Stem Cell Transplant, Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Department of Pediatrics, Pediatric Blood and Marrow Transplantation Program, University Medical Center, Utrecht, the Netherlands.
Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco.
Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
Departement of Hematology, Fundação Dr Amaral de Carvalho, Jaú, Brazil.
Stem Cell Transplant Unit, Hospital Universitario Niño Jesus, Madrid, Spain.
Department of Pediatric Hematology and Oncology, Timone Enfants Hospital, APHM and Aix Marseille Université, Marseille, France.
Department of Paediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Bambino Gesù" Children's Hospital, Rome, Italy; Department of Pediatric Sciences, University of Pavia, Rome, Italy.
Pediatric Hematology Department, Bordeaux-Hospital, Bordeaux University, Lille, France.
CHU de Lille, LIRIC INSERM U995, Université Lille 2, Lille, France.
Department of Pediatrics, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Department of Child Hematology and Oncology, IHOP University Hospital, Hospices Civils de Lyon, Lyon, France.
Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany.
Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Hopital Saint Antoine, Service d'Hématologie et thérapie cellulaire, Paris, France.


Body mass index (BMI) may influence outcomes after allogeneic hematopoietic stem cell transplantation (HSCT). However, the impact of BMI on survival in children undergoing HSCT is not well defined, with conflicting results being reported on this issue. We analyzed 855 patients age 2 to 20 years with diagnosis of acute leukemia who underwent umbilical cord blood transplantation (UCBT) from 1990 to 2015. Patients were classified according to BMI as normal (fifth to 85th percentile), underweight (less than fifth percentile), overweight (85th to 95th percentile), and obese (>95th percentile) using growth charts for age and sex. All patients received single-unit UCBT after a myeloablative conditioning regimen. Diagnosis was acute lymphoblastic leukemia in 68% of the patients. Sixty-one percent of patients (n = 523) were in the normal BMI category, 11% (n = 96) were underweight, 16% (n = 137) overweight, and 12% (n = 99) obese. The cumulative incidence of grade II to IV acute graft-versus-host disease (aGVHD) was 35% (32% to 38%). According to pretransplantation BMI, aGVHD was 46% (33% to 59%) for underweight, 34% (31% to 42%) for normal, 36% (18% to 38%) for overweight, and 27% (15% to 37%) for obese (P = .04). In multivariate analysis, a BMI less than the fifth percentile was associated with higher incidence of acute grade II to IV GVHD compared with normal-BMI patients (hazard ratio,  1.61; 95% confidence interval, 1.15 to 2.26; P = .006). Our results show that being underweight at the time of transplantation is associated with an increased risk of aGVHD, highlighting the importance of nutritional status before UCBT.


Acute leukemia; Body mass index; Children; Umbilical cord blood transplantation; Young adults


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