Patients with morbid obesity don't get life-saving bone marrow transplants

When the patient, a registered nurse, was surgically treated for morbid obe sity she initially lost 54.5 kg. Approximately 2 years after gastric bypass , she received a diagnosis of chronic myelogenous leukemia and subsequently underwent a successful allogenic bone marrow transplant (BMT). When her su rgical history was taken at the transplant facility, the significant weight loss and gastric bypass were discussed. She was informed that at 140 kg, s he would not have been eligible nor considered a candidate for transplant. A search of the literature and a survey of other facilities confirmed this view as typical. The reasons cited were that the chemotherapy dosage requir ed for the morbidly obese weight level would cause fatal organ damage as op posed to organ-sparing dosages, which would not eradicate all leukemic canc er cells. An additional general view was that the morbidly obese could not survive the rigors of the transplant preoperative regimen. This patient had an uneventful recovery and remains disease-free today, 3 y ears after BMT and 5 years after gastric bypass, with a sustained total wei ght loss of 73 kg.