The impact of pre-transplantation diabetes and obesity on acute graft-versus-host disease, relapse and death after allogeneic hematopoietic cell transplantation: a study from the EBMT Transplant Complications Working Party

Lars Klingen Gjærde*, Tapani Ruutu, Christophe Peczynski, William Boreland, Nicolaus Kröger, Didier Blaise, Thomas Schroeder, Régis Peffault de Latour, Tobias Gedde-Dahl, Aleksandr Kulagin, Henrik Sengeløv, Ibrahim Yakoub-Agha, Jürgen Finke, Matthias Eder, Grzegorz Basak, Ivan Moiseev, Hélène Schoemans, Christian Koenecke, Olaf Penack, Zinaida Perić

*Corresponding author for this work

Abstract

Obesity and diabetes can modulate immune responses, which may impact allogeneic HCT outcomes and GvHD. From the EBMT registry, we included 36,539 adult patients who underwent allogeneic HCT for a hematological malignancy between 2016 and 2020. Of these, 5228 (14%) had obesity (BMI ≥ 30 kg/m2), 1415 (4%) had diabetes (requiring treatment with insulin or oral hypoglycemics), and 688 (2%) had obesity + diabetes pre-transplantation. Compared with patients without diabetes or obesity, the hazard ratio (HR) of grade II-IV acute GvHD was 1.00 (95% confidence interval [CI] 0.94-1.06, p = 0.89) for patients with obesity, 0.95 (CI 0.85-1.07, p = 0.43) for patients with diabetes, and 0.96 (CI 0.82-1.13, p = 0.63) for patients with obesity + diabetes. Non-relapse mortality was higher in patients with obesity (HR 1.08, CI 1.00-1.17, p = 0.047), diabetes (HR 1.40, CI 1.24-1.57, p < 0.001), and obesity + diabetes (HR 1.38, CI 1.16-1.64, p < 0.001). Overall survival after grade II-IV acute GvHD was lower in patients with diabetes (HR 1.46, CI 1.25-1.70, p < 0.001). Pre-transplantation diabetes and obesity did not influence the risk of developing acute GvHD, but pre-transplantation diabetes was associated with poorer survival after acute GvHD.

Original languageEnglish
JournalBone Marrow Transplantation
Volume59
Issue number2
Pages (from-to)255-263
Number of pages9
ISSN0268-3369
DOIs
Publication statusPublished - Feb 2024

Keywords

  • Adult
  • Chronic Disease
  • Diabetes Mellitus/epidemiology
  • Graft vs Host Disease/pathology
  • Hematopoietic Stem Cell Transplantation/adverse effects
  • Humans
  • Neoplasm Recurrence, Local
  • Obesity
  • Retrospective Studies
  • Transplantation Conditioning/adverse effects
  • Transplantation, Homologous/adverse effects

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