Survival in overweight and underweight children undergoing hematopoietic stem cell transplantation

Background/objectives: There is a growing body of evidence that nutritional status influences the morbidity and mortality of children undergoing treatment for cancer. The aim of this paper is to determine if nutritional status is associated with survival post-pediatric bone marrow transplant. Subjects/methods: This was a single-center retrospective audit of patients who underwent an autologous or allogeneic hematopoietic stem cell transplant. Patients were divided into three weight categories of underweight, ideal weight and overweight defined by percent ideal body weight. The outcome of interest, overall post transplant survival, was compared between weight categories. Results: Of 113 patients, 15 (13%) were underweight and 41 (36%) were classified as overweight. After adjustment for age, sex, donor source, conditioning therapy and year of transplant, overweight patients were significantly less likely to survive than ideal-weight patients (hazard ratio (HR) 1.91; 95% confidence interval, 1.10–3.31). There was no significant increase in mortality when underweight patients were compared with ideal-weight patients (HR 1.47; 95% confidence interval, 0.57–3.79). Conclusions: Children who are overweight before hematopoietic stem cell transplantation have decreased survival compared with ideal-weight children.