Clinical Research Papers:
Pre-transplant weight loss predicts inferior outcome after allogeneic stem cell transplantation in patients with myelodysplastic syndrome
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Aleksandar Radujkovic1, Natalia Becker2, Axel Benner2, Olaf Penack3, Uwe Platzbecker4, Friedrich Stölzel4, Martin Bornhäuser4, Ute Hegenbart1, Anthony D. Ho1, Peter Dreger1, Thomas Luft1
1Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
2Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
3Campus Benjamin Franklin, Charité, Interdisziplinäre Klinik und Poliklinik für Stammzelltransplantation, Berlin, Germany
4Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
Thomas Luft, e-mail: [email protected]
Keywords: MDS, weight loss, allogeneic stem cell transplantation, relapse, outcome
Received: June 01, 2015 Accepted: August 07, 2015 Published: August 17, 2015
Allogeneic stem cell transplantation (alloSCT) represents a curative therapeutic option for patients with myelodysplastic syndrome (MDS), but relapse and non-relapse mortality (NRM) limit treatment efficacy. Based on our previous observation in acute myeloid leukemia we investigated the impact of pre-transplant weight loss on post-transplant outcome in MDS patients. A total of 111 patients diagnosed with MDS according to WHO criteria transplanted between 2000 and 2012 in three different transplant centers were included into the analysis. Data on weight loss were collected from medical records prior to conditioning therapy and 3–6 months earlier. Patient, disease and transplant characteristics did not differ between patients with weight loss (2–5%, n = 17; > 5%, n = 17) and those without (n = 77). In a mixed effect model, weight loss was associated with higher risk MDS (p = 0.046). In multivariable analyses, pre-transplant weight loss exceeding 5% was associated with a higher incidence of relapse (p < 0.001) and NRM (p = 0.007). Pre-transplant weight loss of 2–5% and > 5% were independent predictors of worse disease-free (p = 0.023 and p < 0.001, respectively) and overall survival (p = 0.043 and p < 0.001, respectively). Our retrospective study suggests that MDS patients losing weight prior to alloSCT have an inferior outcome after transplantation. Prospective studies addressing pre-transplant nutritional interventions are highly warranted.
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