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Metabolic syndrome prevalence and impact on outcomes in patients with chronic graft-versus-host disease

Bone Marrow Transplantation volume 58, pages 1377–1383 (2023)Cite this article

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Abstract

Patients with chronic graft-versus-host disease (cGVHD) are at heightened risk for components of metabolic syndrome (MetS), yet the prevalence and impact of MetS in the cGVHD patient population remain unknown. Adult patients (n = 229) with cGVHD enrolled in the cross-sectional NIH cGVHD Natural History Study (NCT00092235) were evaluated for MetS at enrollment and for variables associated with MetS. A majority (54.1%, 124/229) of the cohort met the diagnostic criteria for MetS. Patients with higher body mass index and lower performance status scores were more likely to have MetS (P < 0.0001; P = 0.026; respectively). Higher circulating erythrocyte sedimentation rate, C-reactive protein, and creatinine concentrations, along with lower estimated glomerular filtration rate, were associated with MetS (P < 0.001; P < 0.004; P = 0.02; P = 0.002; respectively). Patients with MetS compared to patients without MetS had no statistical differences in survival or NRM (5-year OS: 64% [95% CI: 54.8–71.8%] vs. 75.1% [95% CI: 65.6–82.3%]; respectively; overall P = 0.20; 5-year NRM: 21.7% [95% CI: 13.6–30.9%] vs. 10.1% [95% CI: 4.4–18.7%]; respectively; overall P = 0.12). Additionally, there was no difference in cGVHD severity between the two groups. Given the high prevalence of MetS in this cohort, clinicians should screen for its presence before it develops into comorbidities that complicate the course of cGVHD treatment.

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Fig. 1: Overall Survival by Metabolic Syndrome Status.
Fig. 2: Cumulative Incidence of Non-relapse Mortality by Metabolic Syndrome Status.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the patients and families for their participation in the NIH cGVHD Natural History Study. This research was supported [in part] by the Intramural Research Program of the NIH, Center for Cancer Research, the National Cancer Institute, the Clinical Center, the National Eye Institute, the National Institute for Dental and Craniofacial Research, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The views expressed are not representative of the official views of the NIH or the US Government.

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Authors and Affiliations

  1. Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA

    Aaron T. Zhao, Filip Pirsl, Noa G. Holtzman, Eduard Schulz, Alain Mina & Steven Z. Pavletic

  2. Biostatistics and Data Management Section, NCI, NIH, Bethesda, MD, USA

    Seth M. Steinberg

  3. Myeloid Malignancies Program, NIH, Bethesda, MD, USA

    Noa G. Holtzman, Eduard Schulz, Alain Mina & Steven Z. Pavletic

  4. Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA

    Jacqueline W. Mays

  5. Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD, USA

    Edward W. Cowen

  6. Department of Rehabilitation Medicine, NIH Clinical Center, Bethesda, MD, USA

    Leora E. Comis & Galen O. Joe

  7. Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA

    Jack A. Yanovski

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Contributions

ATZ: conceptualization, investigation, writing; FP: conceptualization, data curation and methodology; SMS: statistical analysis; NGH: conceptualization; ED: conceptualization; AM: conceptualization; SZP: conceptualization, investigation, supervision; all authors: review, editing.

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Correspondence to Steven Z. Pavletic.

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Zhao, A.T., Pirsl, F., Steinberg, S.M. et al. Metabolic syndrome prevalence and impact on outcomes in patients with chronic graft-versus-host disease. Bone Marrow Transplant 58, 1377–1383 (2023). https://doi.org/10.1038/s41409-023-02097-y

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