More GVHD Complications Observed Among Patients With Obesity

Multipotent stem cells in the bone marrow: © Juan Gärtner - stock.adobe.com

While obesity is known to be an inflammatory condition, the current research on its effect on patients undergoing stem cell transplants has contradictions.

This issue encouraged researchers at the Cleveland Clinic to look at 531 patients who received stem cell transplants for hematologic malignancies 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.

While no significant differences were found in the survival, relapse, or development of acute GVHD between patients with and without obesity, patients with obesity 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 patients without obesity.

In an interview with Targeted Oncology^TM, Valentina Ardila, MD, second-year resident physician in the internal medicine program at the Cleveland Clinic, who presented the findings at the 2024 Transplantation and Cellular Therapy Tandem Meetings, encouraged further research to understand the complex interplay between obesity, immune response, and transplant outcomes.

Targeted Oncology: What was the rationale or inspiration for the study?

Ardila: Obesity is known to be a proinflammatory condition. We know a lot about its influence on outcomes such as cardiovascular health, etc, but unfortunately, we do not know much about its outcomes on bone marrow transplant and graft-vs-host disease.

Could you speak to some of the unmet needs in this space?

In this space, there is a lot of evidence, both preclinical studies and clinical studies in patients, some of them saying, basically, that obesity has an influence on bone marrow transplant outcomes and GVHD outcomes, and some studies saying it does not. So, there is kind of conflicting evidence. That is why we sought to gather a little more data.

Could you summarize your findings?

We reviewed about 500 patients or so that had a bone marrow transplant at the Cleveland Clinic over the past 14 years. We compared patients [with and without obesity] regarding their incidence of GVHD, organ-affected severity of disease, [and] 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 patients [with obesity] tend to get more chronic skin GVHD and more severe chronic GVHD. There was a tendency for them to have less response to treatment.

What would some of the takeaways be for a practicing oncologist?

In general, even though bone marrow transplant patients are closely followed at their transplant centers, given the timeline of chronic GVHD, it is likely that a community oncologist would see these patients in their practice. Important things to know is to be on the lookout for chronic GVHD, especially of the skin and more severe manifestations and to be careful about treatment, and on the lookout for response to treatment, given these patients are possibly not responding as well.

Given these findings, what kind of conversation should patients who are obese have with their health care team before undergoing stem cell transplant?

With patients that are going to undergo bone marrow transplant, they should address this topic with their physicians, especially regarding the fact that they are going to do surgery. As patients are going to go to bone marrow transplant, they should address this with their treating physicians regarding the possible complications, responses to different treatments or medications, and I do not think obesity is going to be a precluding factor for undergoing transplant, but something to keep in mind.

REFERENCE:

Ardila V, Hong L, Brunstein C, et al. Impact of obesity on graft-versus-host disease and transplant outcomes in patients undergoing allogeneic hematopoietic cell transplant for hematologic malignancies. Presented at: 2024 Transplantation and Cellular Therapies Tandem Meetings; February 21-24, 2024; San Antonio, TX. Abstract 365.