Obesity May Increase Chronic GVHD After Stem Cell Transplant

While obesity is a known inflammatory condition, its effect on patients undergoing stem cell transplants has not been thoroughly investigated.

Researchers at the Cleveland Clinic looked at 531 patients who received stem cell transplants for hematologic malignancies at the Cleveland Clinic between 2010 and 2021. Patients were categorized based on their body mass index as obese or nonobese. The study tracked the development, severity, and treatment response of both acute and chronic graft-vs-host disease (GVHD), alongside other outcomes like relapse and survival.

No significant differences were found in the development of acute GVHD between obese and nonobese patients. However, obese patients were more likely to develop moderate to severe chronic GVHD, particularly with skin involvement, and tended to require stronger medications with lower response rates when compared with nonobese patients. There were no significant differences in overall survival, relapse, or other secondary outcomes.

These findings, which were presented by Valentina Ardila, MD, second-year resident physician in the internal medicine program at the Cleveland Clinic, at the 2024 Transplantation and Cellular Therapy Tandem Meetings, suggest an association between obesity and a higher risk of moderate to severe chronic GVHD in patients receiving stem cell transplants. While no difference was observed in acute GVHD, the potential impact of obesity on chronic GVHD warrants further investigation. More research is needed to understand the complex interplay between obesity, immune response, and transplant outcomes.

Transcription:

0:05 | Obesity is known to be a proinflammatory condition, and we know a lot about its influence on outcomes such as cardiovascular health, etc. But unfortunately, we don't know much about its outcomes on bone marrow transplant and graft-vs-host disease.What we did was we reviewed about 500 patients or so that underwent transplant at the Cleveland Clinic over the past 14 years.

0:25 | So we compared obese and nonobese patients regarding their incidence of GVHD, organ-affected severity of disease, response to treatment. And we also sought to see if there was any difference in nonrelapse mortality and overall survival in these patients. What we found was that obese patients tend to get more chronic skin GVHD, and more severe chronic GVHD.

0:49 | There was a tendency for them to have less response to treatment. In general, even though bone marrow transplant patients are closely followed through their transplant center, given the timeline of chronic GVHD, it is likely that a community oncologist would see these patients in their practice. So important things to know is to be on the lookout for chronic GVHD, especially of the skin and more severe manifestations and a little bit to be careful about treatment and on the lookout for response to treatment given these patients are possibly not responding as well.