Evaluation of Body Mass Index (BMI) as a Prognostic Factor among Patients with Relapsed/Refractory Hodgkin’s Lymphoma (R/R-HL) Undergoing Autologous Bone Marrow/Peripheral Stem Cell Transplantation (Auto-BM/PSCT).

Background: High-dose chemo(radio)therapy (HDC) followed by auto-BM/PSCT is considered an acceptable therapeutic option for patients (pts) with R/R-HL. Various adverse prognostic factors have been previously described in this setting, including resistance to salvage therapy, active disease at the time of transplant, decreased performance status, B symptoms, extranodal disease, and complete remission duration of less than 1 year. On the other hand, overweight state (defined as BMI > or = 28) was associated with reduced overall and event-free survival among pts who received HDC followed by auto-BM/PSCT for non-Hodgkin’s lymphoma. The prognostic significance of excess body weight among pts with R/R-HL who undergo HDC followed by auto-BM/PSCT has not been reported.

Objective: To evaluate the relationship between excess body weight and overall survival (OS) in pts with R/R-HL who receive HDC followed by auto-BM/PSCT.

Methods: A retrospective, single institution study of consecutive pts with R/R-HL who received HDC followed by auto-BM/PSCT at the University of Oklahoma over the last 19 years (1985– 2004) was performed. BMI was calculated as [weight (kg)/height² (m)]. Overweight state was defined as BMI > or = 28. OS was defined as the time period in months from the day of transplant until death, or the last of day of follow-up. Survival curves were estimated according to the Kaplan-Meier method, and were compared between the two groups (control group [BMI < 28] and overweight group [BMI > or = 28]) with the use of the log-rank test. Median survivals of the two groups were also compared by using Wilcoxon-Mann-Whitney test. A two-tailed P-value of < 0.05 was considered statistically significant. SAS^® sofware (version 8.0; Carry, NC) was used for statistical analysis.

Results: 66 pts (40 males, 26 females) were identified, who were 13–69 years old (median 29 years) at the time of transplant. 40 pts (61%) died during follow-up, 4 pts (6%) were lost to follow-up at 15, 27, 58 and 103 months after transplant, and 22 pts (33%) are alive at the time of this analysis (7/30/04), 2–187 months (median 68 months) after transplant. 65 pts were included in this analysis (BMI could not be calculated for one pt). OS for the control group (n₁= 42, 26/42 died) was 30 months (95% CI: 20–69 months) and for the overweight group (n₂=23, 14/23 died) was 42 months (95% C.I. 8.0- N/A months). Overall survival did not differ between the two groups (p-values for log-rank and Wilcoxon-Mann-Whitney tests, 0.8109 and 0.7367, respectively).

Conclusion: Excess body weight is not a prognostic factor in patients with R/R-HL who undergo HDC followed by auto-BM/PSCT. A prospective study to evaluate and confirm our findings is warranted.