Skip to main content

Advertisement

SpringerLink
Log in

Decreased body mass index is associated with poor prognosis in patients with multiple myeloma

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Obesity increases morbidity in and mortality of patients with various types of cancer. However, the proportion of obese individuals in Asia is smaller than that in Western populations and only a few studies have explored the effect of obesity at the time of diagnosis on the survival of Asian patients with multiple myeloma (MM). Therefore, we investigated the relationship between body mass index (BMI) at diagnosis, and clinical manifestations, in MM patients. We also measured overall survival (OS) in terms of BMI groupings. Patients were subdivided into three groups based on hazard ratios (HRs) associated with BMIs of <20, 20–24.9, and ≥25 kg/m2. The median survival times were 25.5 months in patients with a BMI of <20 kg/m2, 56.8 months for those with a BMI of 20–24.9 kg/m2, and 76 months in patients with a BMI of ≥25 kg/m2. Patients with a BMI of <20 kg/m2 exhibited poorer performance status and a lower hemoglobin level at diagnosis than did others, and renal failure (serum creatinine ≥2 mg/dl) was much more often observed in such patients than in those of other groups. Both univariate and multivariate analyses showed that BMI <20 kg/m2 (HR 1.831, 95 % confidence interval [CI] 1.005–3.337; P = 0.048) and performance of autologous stem cell transplantation (HR 0.257, 95 % CI 0.139–0.475, P < 0.001) were significantly (negatively) associated with OS. In conclusion, a low BMI (<20 kg/m2) at the time of diagnosis was associated with poor survival of MM patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kyle RA, Rajkumar SV (2004) Multiple myeloma. N Engl J Med 351:1860–1873

    Article  PubMed  CAS  Google Scholar 

  2. Becker N (2011) Epidemiology of multiple myeloma. Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer 183:25–35

  3. Kristinsson SY, Landgren O, Dickman PW et al (2007) Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. J Clin Oncol 25:1993–1999

    Article  PubMed  Google Scholar 

  4. Brenner H, Gondos A, Pulte D (2008) Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 111:2521–2526

    Article  PubMed  CAS  Google Scholar 

  5. Dewys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497

    Article  PubMed  CAS  Google Scholar 

  6. Obesity rates in the OECD and beyond (2012) www.oecd.org/health/fitnotfat. Accessed 4 Dec 2013

  7. Tee ES (2002) Obesity in Asia: prevalence and issues in assessment methodologies. Asia Pac J Clin Nutr 11(Suppl 8):S694–S701

    Article  PubMed  Google Scholar 

  8. WHO Expert Consultation (2004) Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  9. Consultation WHOE (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  10. Zheng W, McLerran DF, Rolland B et al (2011) Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 364:719–729

    Article  PubMed  CAS  Google Scholar 

  11. The Korean Society for the Study of Obesity (2009) Guideline of obesity in Korean http://kosso.or.kr. Accessed 5 Sept 2011

  12. Waalkes S, Merseburger AS, Kramer MW et al (2010) Obesity is associated with improved survival in patients with organ-confined clear-cell kidney cancer. Cancer Causes Control 21:1905–1910

    Article  PubMed  Google Scholar 

  13. Yang R, Cheung MC, Pedroso FE et al (2011) Obesity and weight loss at presentation of lung cancer are associated with opposite effects on survival. J Surg Res 170:e75–e83

    Article  PubMed Central  PubMed  Google Scholar 

  14. Carson KR, Bartlett NL, McDonald JR et al (2012) Increased body mass index is associated with improved survival in United States veterans with diffuse large B-cell lymphoma. J Clin Oncol 30:3217–3222

    Article  PubMed Central  PubMed  Google Scholar 

  15. Parr CL, Batty GD, Lam TH et al (2010) Body-mass index and cancer mortality in the Asia-Pacific Cohort Studies Collaboration: pooled analyses of 424,519 participants. Lancet Oncol 11:741–752

    Article  PubMed  Google Scholar 

  16. Bozzetti F, Group SW (2009) Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 17:279–284

    Article  PubMed  Google Scholar 

  17. Skipworth RJ, Stewart GD, Dejong CH et al (2007) Pathophysiology of cancer cachexia: much more than host–tumour interaction? Clin Nutr 26:667–676

    Article  PubMed  CAS  Google Scholar 

  18. Martin L, Birdsell L, Macdonald N et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539–1547

    Article  PubMed  Google Scholar 

  19. Moses AW, Slater C, Preston T et al (2004) Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90:996–1002

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  20. Bachmann J, Heiligensetzer M, Krakowski-Roosen H et al (2008) Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg 12:1193–1201

    Article  PubMed  Google Scholar 

  21. Miya T, Goya T, Yanagida O et al (1998) The influence of relative body weight on toxicity of combination chemotherapy with cisplatin and etoposide. Cancer Chemother Pharmacol 42:386–390

    Article  PubMed  CAS  Google Scholar 

  22. Kim WY, Woo SU, Seo JH et al (2011) Toxicities, dose reduction and delay of docetaxel and paclitaxel chemotherapy in breast cancer without distant metastases. J Cancer Res Ther 7:412–415

    Article  PubMed  CAS  Google Scholar 

  23. Bosly A, Bron D, Van Hoof A et al (2008) Achievement of optimal average relative dose intensity and correlation with survival in diffuse large B-cell lymphoma patients treated with CHOP. Ann Hematol 87:277–283

    Article  PubMed  CAS  Google Scholar 

  24. Blade J, Fernandez-Llama P, Bosch F et al (1998) Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution. Arch Intern Med 158:1889–1893

    Article  PubMed  CAS  Google Scholar 

  25. Knudsen LM, Hjorth M, Hippe E (2000) Renal failure in multiple myeloma: reversibility and impact on the prognosis. Nordic Myeloma Study Group. Eur J Haematol 65:175–181

    Article  PubMed  CAS  Google Scholar 

  26. Sakhuja V, Jha V, Varma S et al (2000) Renal involvement in multiple myeloma: a 10-year study. Ren Fail 22:465–477

    Article  PubMed  CAS  Google Scholar 

  27. Phung DT, Wang Z (2013) Risk of pneumonia in relation to body mass index in Australian Aboriginal people. Epidemiol Infect 141(12):2497–2502

    Article  PubMed  CAS  Google Scholar 

  28. Almirall J, Bolibar I, Balanzo X et al (1999) Risk factors for community-acquired pneumonia in adults: a population-based case–control study. Eur Respir J 13:349–355

    Article  PubMed  CAS  Google Scholar 

  29. Munshi NC, Anderson KC, Bergsagel PL et al (2011) Consensus recommendations for risk stratification in multiple myeloma: report of the International Myeloma Workshop Consensus Panel 2. Blood 117:4696–4700

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  30. Zhou Y, Barlogie B, Shaughnessy JD Jr (2009) The molecular characterization and clinical management of multiple myeloma in the post-genome era. Leukemia 23:1941–1956

    Article  PubMed Central  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All patients gave written informed consent prior to inclusion in the study. No author has any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea

    Sung-Hoon Jung, Deok-Hwan Yang, Jae-Sook Ahn, Seung-Shin Lee, Seo-Yeon Ahn, Yeo-Kyeoung Kim, Hyeoung–Joon Kim & Je-Jung Lee

  2. The Brain Korea 21 Project, Center for Biomedical Human Resources, Chonnam National University, Gwangju, Republic of Korea

    Je-Jung Lee

Authors
  1. Sung-Hoon Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deok-Hwan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jae-Sook Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung-Shin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seo-Yeon Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yeo-Kyeoung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyeoung–Joon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Je-Jung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Je-Jung Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jung, SH., Yang, DH., Ahn, JS. et al. Decreased body mass index is associated with poor prognosis in patients with multiple myeloma. Ann Hematol 93, 835–840 (2014). https://doi.org/10.1007/s00277-013-1977-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-013-1977-9

Keywords

Search

Navigation