Body mass index is unrelated to the response to autologous hematopoietic stem cell transplantation in persons with multiple sclerosis.
Background: Multiple sclerosis (MS) is a chronic autoimmune disorder that compromises the central nervous system; it is characterized by inflammation, demyelination, and neuronal degeneration. Its complex etiology involves genetic, environmental, and lifestyle factors, with emerging research highlighting the importance of nutritional status, particularly the body mass index (BMI), in disease progression. While BMI has been linked to other neurodegenerative conditions, its specific impact on MS remains unclear.
Objective: This study aims to analyze the association between patient BMI and the response to autologous hematopoietic stem cell transplantation (aHSCT) and disease progression, as reflected by changes in the Expanded Disability Status Scale (EDSS) 12 months post-transplant. The goal is to determine whether BMI influences treatment response and determine potential predictors of outcomes in MS patients undergoing autologous HSCT.
Methods: We conducted a retrospective study of 457 patients with MS who underwent autologous HSCT between May 2015 and June 2023. Patients were classified into BMI categories: underweight, normal weight, overweight, and obese. Response to HSCT was assessed by changes in the Expanded Disability Status Scale (EDSS), 3- and 12-months post-transplant. A positive response was defined as EDSS stabilization or improvement.
Results: The cohort included 16 underweight, 227 normal weight, 138 overweight, and 76 obese patients. Overall, 77 % of patients responded positively to HSCT: the median EDSS score decreased from 5.5 (IQR 3.5-6.5) to 5.0 (IQR 2.5-6.5) (p = 0.0049). Positive responses were observed in 100 % underweight, 75 % normal-weight, and 75 % overweight patients, with no significant differences in response rates across BMI categories.
Conclusions: BMI was not associated with the clinical response to autologous HSCT in MS patients. These findings suggest that the efficacy of aHSCT is independent of BMI, although further studies are needed to explore the broader implications of BMI on treatment outcomes.