Comparison of nutritional risk index and body mass index in predicting survival outcomes in patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective study

Bruna Silvestre Françoso; Isabela Laurêncio Schiavoni; Thauany Nantes Guirao; Barbara David Dos Santos; Thalita Cristina de Mello Costa; Anderson Marliere Navarro; Fabiola Traina; Juliana Maria Faccioli Sicchieri

doi:10.1016/j.htct.2026.106254

Comparison of nutritional risk index and body mass index in predicting survival outcomes in patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective study

Hematol Transfus Cell Ther. 2026 Feb 13;48(2):106254. doi: 10.1016/j.htct.2026.106254. Online ahead of print.

Authors

Bruna Silvestre Françoso¹, Isabela Laurêncio Schiavoni², Thauany Nantes Guirao², Barbara David Dos Santos², Thalita Cristina de Mello Costa³, Anderson Marliere Navarro⁴, Fabiola Traina³, Juliana Maria Faccioli Sicchieri⁴

Affiliations

¹ Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil. Electronic address: bruna.francoso@usp.br.
² Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil.
³ Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Brazil.
⁴ Department of Health Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.

Abstract

Introduction: Allogeneic hematopoietic stem cell transplantation is a viable therapeutic option for several serious diseases however it is a high-risk procedure because it involves high-toxicity protocols with many adverse effects. Existing factors, such as the underlying disease and nutritional status, may influence the outcome. The objective of this study was to evaluate the Nutritional Risk Index as a prognostic tool by correlating it with body mass index, nutritional status, and clinical outcomes in patients undergoing hematopoietic stem cell transplantation.

Methods: This single center retrospective study was conducted collected sociodemographic, anthropometric, biochemical, and clinical data before conditioning and 30 days post-transplantation. Statistical analyses were performed using the Mann-Whitney test and Spearman's correlation. Overall survival was estimated using the Kaplan-Meier method, with comparisons conducted via the Gehan-Breslow-Wilcoxon test. A Cox Proportional Hazards regression analysis was employed to identify factors associated with mortality; variables demonstrating a p-value ≤0.20 in the univariate analysis were included in the multivariate model. For all analyses, statistical significance was defined as a p-value <0.05.

Results: Seventy-seven participants were included, with an average age of 41 years. According to the nutritional risk index, the entire sample was classified as having severe nutritional risk. The body mass index showed that 6.4 % were malnourished, 19.4 % were obese, and 12.9 % had hypoalbuminemia. The estimated survival curve identified a significant difference for patients aged <45 years with survival being significantly longer (p-value = 0.01). Higher albumin levels (≥3.5) after transplantation were associated with longer survival (p-value = 0.04). Sex, body mass index, albumin level before conditioning, and graft-versus-host disease showed no significant differences in terms of survival. Albumin levels ≥3.5 g/dL after transplantation were marginally associated with a lower mortality risk and malignant disease showed a trend toward increased mortality.

Conclusion: These findings underscore the clinical utility of prognostic indices, such as the Nutritional Risk Index and albumin levels, during the pre-transplant period, emphasizing the necessity for early nutritional interventions in hematopoietic stem cell transplantation patients.

Keywords: Allogeneic hematopoietic stem cell transplantation; Body mass index; Malnutrition; Nutritional assessment; Nutritional risk index (NRI); Nutritional screening.