Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee

Biol Blood Marrow Transplant. 2014 May;20(5):600-16. doi: 10.1016/j.bbmt.2014.01.019. Epub 2014 Jan 23.


Hematopoietic stem cell transplantation (HCT) is a potentially life-saving therapy for patients with malignant and nonmalignant disease states. This article reviews the current published literature on the dosing of pharmacologic agents used for HCT preparative regimens with specific focus on the obese patient population. The review found that dose adjustments for obesity have, to date, been based empirically or extrapolated from published data in the nontransplantation patient population. As a result, the Committee determined that clear standards or dosing guidelines are unable to be made for the obese population because Level I and II evidence are unavailable at this time. Instead, the Committee provides a current published literature review to serve as a platform for conditioning agent dose selection in the setting of obesity. A necessary goal should be to encourage future prospective trials in this patient population because further information is needed to enhance our knowledge of the pharmacokinetics and pharmacodynamics of conditioning agents in the setting of obesity.

Keywords: Dosing; Hematopoietic cell transplantation; Obesity; Preparative regimens.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Antilymphocyte Serum / therapeutic use
  • Bone Marrow Transplantation*
  • Busulfan / therapeutic use
  • Cyclophosphamide / therapeutic use
  • Cytarabine / therapeutic use
  • Drug Administration Schedule
  • Drug Dosage Calculations
  • Etoposide / therapeutic use
  • Hematologic Diseases* / complications
  • Hematologic Diseases* / pathology
  • Hematologic Diseases* / therapy
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Melphalan / therapeutic use
  • Myeloablative Agonists* / therapeutic use
  • Obesity* / complications
  • Obesity* / pathology
  • Obesity* / therapy
  • Transplantation Conditioning*


  • Antilymphocyte Serum
  • Busulfan
  • Cyclophosphamide
  • Cytarabine
  • Etoposide
  • Melphalan
  • Myeloablative Agonists