Ideal Body Weight Is Useful For Predicting Neutrophil Engraftment and Platelet Recovery for Overweight and Obese Recipients in Single-Unit Cord Blood Transplantation

Yosuke Okada; Hideki Nakasone; Takaaki Konuma; Naoyuki Uchida; Masatsugu Tanaka; Yasuhiro Sugio; Nobuyuki Aotsuka; Akihiko Nishijima; Yuna Katsuoka; Takahide Ara; Shuichi Ota; Makoto Onizuka; Masashi Sawa; Takafumi Kimura; Takahiro Fukuda; Yoshiko Atsuta; Junya Kanda; Fumihiko Kimura

doi:10.1016/j.jtct.2022.05.006

Ideal Body Weight Is Useful For Predicting Neutrophil Engraftment and Platelet Recovery for Overweight and Obese Recipients in Single-Unit Cord Blood Transplantation

Transplant Cell Ther. 2022 Aug;28(8):504.e1-504.e7. doi: 10.1016/j.jtct.2022.05.006. Epub 2022 May 13.

Authors

Yosuke Okada¹, Hideki Nakasone², Takaaki Konuma³, Naoyuki Uchida⁴, Masatsugu Tanaka⁵, Yasuhiro Sugio⁶, Nobuyuki Aotsuka⁷, Akihiko Nishijima⁸, Yuna Katsuoka⁹, Takahide Ara¹⁰, Shuichi Ota¹¹, Makoto Onizuka¹², Masashi Sawa¹³, Takafumi Kimura¹⁴, Takahiro Fukuda¹⁵, Yoshiko Atsuta¹⁶, Junya Kanda¹⁷, Fumihiko Kimura¹⁸

Affiliations

¹ Department of Hematology, National Defense Medical College Hospital, Saitama, Japan; Department of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan. Electronic address: yokada@jichi.ac.jp.
² Department of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
³ Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
⁴ Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan.
⁵ Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan.
⁶ Department of Hematology, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
⁷ Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Chiba, Japan.
⁸ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁹ Department of Hematology, National Hospital Organization Sendai Medical Center, Miyagi, Japan.
¹⁰ Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan.
¹¹ Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan.
¹² Department of Hematology/Oncology, Tokai University School of Medicine, Kanagawa, Japan.
¹³ Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan.
¹⁴ Preparation Department, Japanese Red Cross Kinki Block Blood Center, Osaka, Japan.
¹⁵ Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
¹⁶ Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan.
¹⁷ Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁸ Department of Hematology, National Defense Medical College Hospital, Saitama, Japan.

PMID: 35577325
DOI: 10.1016/j.jtct.2022.05.006

Abstract

Because cord blood (CB) units are usually selected based on the cell dose per kilogram, overweight (body mass index [BMI] ≥25 kg/m²to < 30 kg/m²) and obese (30 kg/m² ≤ BMI) recipients tend to have difficulty in getting appropriate CB units. In general, actual body weight (ABW) is used for CB unit selection. However, ideal body weight (IBW) has been reported to be more closely correlated with successful engraftment after autologous, allogeneic bone marrow, and peripheral blood stem cell transplantation than ABW. We conducted this analysis to clarify the threshold of CD34⁺ cell doses based on ideal body weight (CD34^IBW) and to compare the outcomes among the groups stratified by the threshold according to actual body weight (CD34^ABW) and CD34^IBW for overweight and obese recipients in cord blood transplantation (CBT). We retrospectively analyzed 650 overweight and obese recipients who received single-unit CBT. To focus on the recipients who received a low CD34⁺ cell dose/kg, those who received 1.5×10⁵ CD34⁺ cells/ABW or more were excluded. Using a cut-off of 0.8×10⁵ CD34⁺ cells/kg, we compared the outcomes in 3 groups with low CD34^ABW and low CD34^IBW (CD34^Low/Low), low CD34^ABW but high CD34^IBW (CD34^Low/High), and high CD34^ABW and high CD34^IBW (CD34^High/High). Hematopoietic recoveries were significantly delayed in the CD34^Low/Low group compared with those in the CD34^Low/High group (hazard ratio [HR] 0.67 for neutrophil, P < .001; HR 0.72 for platelet, P = .014), whereas those were comparable in the CD34^Low/High and CD34^High/High groups (HR 1.22 for neutrophil, P = .16; HR 1.29 for platelet, P = .088). Moreover, the CD34^Low/High group demonstrated longer overall survival than the CD34^Low/Low group (HR 1.48, P = .011) and comparable survival to the CD34^High/High group (HR 0.93, P = .68). This finding may address the lack of availability of CB units for some overweight and obese recipients for whom suitable donors are unavailable. Further investigations are warranted to evaluate the appropriateness of ABW and IBW.

Keywords: CD34; Cord blood transplantation; Ideal body weight; Overweight and obese.

MeSH terms

Antigens, CD34
Body Weight
Cord Blood Stem Cell Transplantation*
Hematopoietic Stem Cell Transplantation*
Humans
Ideal Body Weight
Neutrophils
Obesity / therapy
Overweight / therapy
Retrospective Studies

Substances

Antigens, CD34