Advertisement

Annals of Hematology

, Volume 91, Issue 11, pp 1795–1801 | Cite as

The use of adjusted ideal body weight for overweight patients undergoing HPC mobilisation for autologous transplantation

  • C. HicksEmail author
  • A. Trickett
  • Y. L. Kwan
  • S. Ramanathan
Original Article

Abstract

Generally, patients’ actual body weight (ABW) is used to calculate the number of CD34+ cells to be harvested for autologous haematopoietic progenitor cell (HPC) transplantation. In our institution, ‘overweight’ patients weighing at least 25 % more than their ideal body weight (IBW) have their adjusted ideal body weight (AdjIBW) used for determination of blood volume to be processed to achieve a minimum target of CD34+ cells per kilogram, as well as CD34+ cell dosage calculation at transplant. AdjIBW is calculated as follows: AdjIBW = IBW + 0.25 × (actual weight − IBW). We have used AdjIBW for 65/153 patients who have had autologous HPC harvests, with a median AdjIBW of 69 kg (range, 50–110 kg). Median actual weight was 90 kg (range, 62–175 kg). Median volume of peripheral blood processed to achieve a minimum 2 × 106 CD34+ cells/kg for these patients was 13.2 L (range, 5–35 L), and the median CD34+ cells × 106/kg collected for AdjIBW was 6.3 (range, 1.7–33). For normal-weight patients (n = 88; median ABW, 75 kg; range, 49–98 kg), the corresponding median apheresis volume was 16 L (range, 7–24 L), and median CD34+ cells × 106/kg harvested was 4.5 (range, 1.4–15.9). In total, 35 in a total transplant cohort of 82 patients had AdjIBW used to determine CD34+ cell dose at time of transplant, with a median of 4.5 × 106/kg, (if their ABW was used in the calculation; 3.1 × 106/kg), compared to median dose of 3.2 × 106/kg ABW for the normal-weight patient cohort. All patients engrafted with no significant difference between median times to neutrophil and platelet engraftment for the overweight (13 and 15 days, respectively) compared with normal-weight (12 and 14 days, respectively) patient cohorts. We conclude that the use of AdjIBW is a useful tool for successful harvest and subsequent transplant for overweight patients, with no adverse effect on engraftment times.

Keywords

Ideal body weight Actual body weight Adjusted ideal body weight CD34+ cell dose Engraftment 

Notes

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Desikan KR, Tricot G, Munshi NC, Annaissie E, Spoon D, Fassas A et al (2001) Preceding chemotherapy, tumour load and age influence engraftment in multiple myeloma patients mobilized with granulocycte colony-stimulating factor alone. Br J Haematol 112:242–247PubMedCrossRefGoogle Scholar
  2. 2.
    The ABMTRR Steering Committee of the BMTSANZ Australian Bone Marrow Transplant Recipient Registry (ABMTRR) Annual Data Summary 2008Google Scholar
  3. 3.
    Pasquini MC, He V, Perez WS (2006) CIBMTR summary slides part 1. CIBMTR Newsletter 12:5–7Google Scholar
  4. 4.
    Bessinger W, Appelbaum F, Rowley S, Storb R, Sanders J, Lilleby K et al (1995) Factors that influence collection and engraftment of autologous peripheral blood-stem cells. J Clin Oncol 13:2547–2555Google Scholar
  5. 5.
    Singhal S, Gordon LI, Tallman MS, Winter JN, Evens AO, Frankfurt SF et al (2006) Ideal rather than actual body weight should be used to calculate cell dose in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 37:553–557PubMedCrossRefGoogle Scholar
  6. 6.
    Waples JM, Moreb JS, Sugrue M, Belanger G, Kubilis P, Lynch JW et al (1999) Comparison of autologous peripheral blood stem cell dosing by ideal vs actual body weight. Bone Marrow Transplant 23:867–873PubMedCrossRefGoogle Scholar
  7. 7.
    Ali MY, Oyama Y, Monreal JN, Winter JN, Tallman MS, Williams SF et al (2003) Ideal or actual body weight to calculate CD34+ cell doses for autologous hematopoietic stem cell transplantation? Bone Marrow Transplant 31:861–864PubMedCrossRefGoogle Scholar
  8. 8.
    Cilley J, Rihn C, Monreal J, Gordon LI, Singhal S, Tallman M et al (2004) Ideal or actual body weight to calculate CD34+ cell doses for allogeneic hematopoietic stem cell transplantation? Bone Marrow Transplant 33:161–164PubMedCrossRefGoogle Scholar
  9. 9.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241PubMedCrossRefGoogle Scholar
  10. 10.
    Australian Bureau of Statistics 4364.0 National Health Survey: Summary of Results, 2007–08. Reissued 2009Google Scholar
  11. 11.
    Harousseau J-L, Moreau P (2009) Autologous hematopoietic stem-cell transplantation for multiple myeloma. N Engl J Med 360:2645–2654PubMedCrossRefGoogle Scholar
  12. 12.
    Gren B, Duffull SB (2004) What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol 58:119–133CrossRefGoogle Scholar
  13. 13.
    Gibbs JP, Gooley T, Corneau B, Murray G, Stewart P, Appelbaum F et al (1999) The impact of obesity and disease on busulfan oral clearance in adults. Blood 93:4436–4440PubMedGoogle Scholar
  14. 14.
    Topcuoglu P, Soydan EA, Ekiz F, Ayyildiz E, Dalva K, Ozcan M et al (2007) How to calculate the quantity of CD34+ cells infused? A single centre cohort study based on actual, ideal or adjusted ideal body weight. Transf Apher Sci 36:275–280CrossRefGoogle Scholar
  15. 15.
    Devine BJ (1974) Gentamicin therapy. Drug Intel Clin Phar 8:650–655Google Scholar
  16. 16.
    Trickett AE, Smith S, Kwan YL (2001) Accurate calculation of blood volume to be processed by aphaeresis to achieve target CD34+ cell numbers of PBPC transplantation. Cytotherapy 3:5–10PubMedCrossRefGoogle Scholar
  17. 17.
    Sutherland DR, Anderson L, Keeney M, Nayar R, Chin-Yee I (1996) The ISHAGE guidelines for CD34+ cell determination by flow cytometry. J Hematother 5:213–226PubMedCrossRefGoogle Scholar
  18. 18.
    Singh V, Krishnamurthy J, Duffey S, Meagher R, Villa M, Monreal J et al (2009) Actual or ideal body weight to calculate CD34+ cell dose in patients undergoing autologous hematopoietic SCT for myeloma? Bone Marrow Transplant 43:301–305PubMedCrossRefGoogle Scholar
  19. 19.
    Maclean PS, Parker AN, McQuaker IG, Clark AD, Farrell E, Douglas KW (2007) Ideal body weight correlates better with engraftment after PBSC autograft then actual body weight, but is under-estimated in myeloma patients possibly due to disease-related height loss. Bone Marrow Transplant 40:665–669PubMedCrossRefGoogle Scholar
  20. 20.
    Stroncek DF, Fautsch SK, Lasky LC, Hurd DD, Ramsay MK, McCullough J (1991) Adverse reactions in patients transfused with cryopreserved marrow. Transfusion 31:521–526PubMedCrossRefGoogle Scholar
  21. 21.
    Zambelli A, Poggi G, Da Prada G, Pedrazzoli P, Cuomo A, Miotti D (1998) Clinical toxicity of cryopreserved circulating progenitor cells infusion. Anticancer Res 18(6B):4705–4708PubMedGoogle Scholar
  22. 22.
    Donmez A, Tombuloglu M, Gungor A, Soyer N, Saydam G, Cagirgan S (2007) Clinical side effects during peripheral blood progenitor cell infusion. Transfus Apher Sci 36:95–101PubMedCrossRefGoogle Scholar
  23. 23.
    Ungerstedt JS, Waltz E, Uttervall K, Johansson B-M, Wahlin BE, Nassman P et al (2011) Autologous hematopoietic stem cell transplantation in multiple myeloma and lymphoma: an analysis of factors influencing stem cell collection and haematological recovery. Med Oncol. doi: 10.1007/s12032-011-0029-3

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • C. Hicks
    • 1
    • 2
    • 5
    Email author
  • A. Trickett
    • 2
    • 3
  • Y. L. Kwan
    • 4
  • S. Ramanathan
    • 1
  1. 1.Department of Clinical HaematologySt George HospitalSydneyAustralia
  2. 2.Department of MedicineUniversity of New South WalesSydneyAustralia
  3. 3.The Agency for Clinical Innovation BMT Network NSWSydneyAustralia
  4. 4.Department of HaematologyConcord HospitalSydneyAustralia
  5. 5.Bone Marrow Transplant Laboratory, Department of Clinical HaematologySt. George HospitalSydneyAustralia

Personalised recommendations