Chemotherapy Dose Adjustment for Obese Patients Undergoing Hematopoietic Stem Cell Transplantation: A Survey on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Noga Shem-Tov

Myriam Labopin

Leila Moukhtari

Fabio Ciceri

Avichai Shimoni+2 authors

Background.

Appropriate chemotherapy dosing for obese patients with malignant diseases is a significant challenge because limiting chemotherapy doses in these patients may negatively influence outcome. There is a paucity of information addressing high-dose chemotherapy in obese patients undergoing hematopoietic stem cell transplantation (HSCT).

Methods.

The Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) designed an electronic survey to assess current practice of dose adjustment of chemotherapy in obese patients undergoing HSCT.

Results.

A total of 56 EBMT centers from 27 countries responded to the online survey. Overall, 45 centers declared that they routinely adjust chemotherapy doses for obese patients (80.5%), and only 11 (19.5%) declared they do not adjust dose. Among the former group, most used body mass index as the parameter for defining obesity (28 centers, 62%). The method for determining the weight for chemotherapy calculation was actual body weight (ABW) in 16 centers, ideal body weight (IBW) in 10 centers, IBW plus 25% of the difference between IBW and ABW in 16 centers, and other methods for the rest. Among centers that used dose adjustment, 44% also capped the dose at 2 m^{for a chemotherapy dose based on body surface area (BSA), whereas 56% did not cap. Interestingly, most of the centers (9 of 11) that did not adjust dose for weight also did not cap the BSA at 2 m}^.

Conclusion.

This EBMT survey revealed large diversity among transplant centers regarding dose-adjustment practice for high-dose conditioning chemotherapy. Our next step is to analyze outcomes of transplantation according to dose-adjustment practice and, subsequently, to formulate a methodology for future prospective studies.

Supplementary Material

Supplemental Data:

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^{Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel;}^{EBMT Acute Leukemia Working Party and Registry, Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris University, Paris, France;}^{San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy;}^{Hematology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain;}^{Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland;}^{Department of Hematology and Oncology, Klinikum Augsburg, Ludwing-Maximilinas-Universitat Munich, Germany}

^{Corresponding author.}

^{Contributed equally.}

Correspondence: Noga Shem-Tov, M.D., Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, 52621, Israel. Telephone: 972-3-5305340; E-Mail: li.vog.htlaeh.abehs@votmehs.agon

Disclosures of potential conflicts of interest may be found at the end of this article.

Received 2014 May 8; Accepted 2014 Oct 13.

Abstract

Background.

Methods.

Results.

Conclusion.

Keywords: Obesity, Dose adjustment, Hematopoietic stem cell transplantation, Conditioning

Abstract

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Acknowledgments

The authors acknowledge the 56 participating centers, which are listed in the supplemental online data.

Acknowledgments

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