Association between body mass index and survival after hematopoietic stem cell transplantation

Baek, Han-Sang; Lee, Jong Hyuk; Lee, Joonyub; Lee, Seung-Hwan; Min, Gi June; Park, Sung-Soo; Park, Silvia; Lee, Sung-Eun; Cho, Byung-Sik; Eom, Ki-Seong; Kim, Yoo-Jin; Lee, Seok; Kim, Hee-Je; Min, Chang-Ki; Cho, Seok-Goo; Lee, Jong Wook; Yoon, Jae-Ho

doi:2025.40.4.645

Korean J Intern Med > Volume 40(4); 2025 > Article

ORIGINAL ARTICLE

Endocrinology-metabolism

Korean J Intern Med. 2025;40(4):645-656. doi: https://doi.org/10.3904/kjim.2024.246

Association between body mass index and survival after hematopoietic stem cell transplantation

Han-Sang Baek¹, Jong Hyuk Lee², Joonyub Lee³, Seung-Hwan Lee^3,4, Gi June Min⁵, Sung-Soo Park⁵, Silvia Park⁵, Sung-Eun Lee⁵, Byung-Sik Cho⁵, Ki-Seong Eom⁵, Yoo-Jin Kim⁵, Seok Lee⁵, Hee-Je Kim⁵, Chang-Ki Min⁵, Seok-Goo Cho⁵, Jong Wook Lee⁵, and Jae-Ho Yoon⁵

¹Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
²Department of Hematology, Catholic Hematology Hospital, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
³Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
⁴Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
⁵Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding Author: Jae-Ho Yoon , Tel: +82-2-2258-6270, Fax: +82-2-599-3589, Email: royoon@catholic.ac.kr

Received: July 14, 2024; Revised: November 19, 2024; Accepted: February 18, 2025.

Abstract

Background/Aims: The unclear relationship between body mass index (BMI) and post-hematopoietic stem cell transplantation (HSCT) mortality was investigated, including the impact of metabolic diseases.
Methods: This retrospective study conducted at a Korean tertiary hospital (2009–2021) included patients who underwent HSCT. Patients were categorized as underweight (BMI < 18.5 kg/m², n = 106), normal (BMI 18.5–22.9 kg/m², n = 1,345), overweight (BMI 23.0–24.9 kg/m², n = 980), or obese (BMI ≥ 25.0 kg/m², n = 1,471). Diabetes mellitus (DM), hypertension, and dyslipidemia were identified by disease codes or medication prescriptions. A Cox proportional hazards model was used to analyze mortality risks.
Results: Over 108 months, 29.8% (1,164/3,902) of the participants died. Patients with underweight had significantly higher mortality (adjusted HR 1.76, 95% CI 1.29–2.40, p < 0.001) than in those with normal BMI. Patients with overweight and obesity did not show increased mortality. Post-HSCT, DM significantly raised mortality risk (HR 3.36, 95% CI 2.86–3.94, p < 0.001), whereas newly diagnosed dyslipidemia was associated with lower mortality (HR 0.27, 95% CI 0.23–0.33, p < 0.001). Post-transplant hypertension had no significant impact on mortality (HR 1.10, 95% CI 0.95–1.28, p = 0.184).
Conclusions: Post-HSCT, obesity is not a prognostic factor for poor survival; however, certain metabolic diseases have diverse effects on mortality.

Keywords: Body mass index ; Obesity ; Hematopoietic stem cell transplantation ; Mortality ; Underweight