Impact of Cannabis Use on Clinical Outcomes in Bone Marrow Transplant Patients: A Nationwide Analysis

Introduction

Cannabis use, particularly CBD use, although initially recreational, has now transitioned into the therapeutic realm and is now an effective FDA-approved treatment of various conditions, including Lennox-Gastaut syndrome. A phase-II trial also demonstrated better 12 and 18-month outcomes in patients who received CBD in addition to cyclosporine and MTX for acute graft vs host disease prophylaxis in patients receiving matched sibling, matched-unrelated, and 1-antigen-mismatched unrelated donor allotransplants. Our nationwide study aims to shed light on the association between cannabis use and various outcomes in bone marrow transplant (BMT) patients.

Methods

We performed a retrospective cohort study using the National Inpatient Sample (NIS) database from 2016 to 2021. Patients undergoing bone marrow transplantation (BMT) were categorized into those with cannabis use (BMT+ CU+) and those without (BMT+ CU-). We analyzed demographic data and clinical outcomes, including mortality, transfusions, sepsis, septic shock, and bleeding. Adjusted odds ratios (aORs) were calculated using multivariable logistic regression to compare outcomes between the two groups. Statistical significance was set at p < 0.05.

Results

Of a total sample of 139,085 adult hospitalizations undergoing BMT from 2016 to 2021 in the NIS database, 1,800 were reported to have cannabis use (CU). The median age of the sample was 43.04 years in those with CU (BMT+ CU+) and 48.67 years in those without CU (BMT+ CU-). White patients formed a majority of the BMT+ CU+ and BMT+ CU- cohorts at 61.36% and 67.09% respectively. The majority of the patients of BMT+ CU+ belonged to the lowest income quartiles at 28.05% in the lowest quartile and 28.33% in the second quartile. In contrast, the majority of the patients in the BMT+ CU- cohort belonged to the highest income quartiles, at 26.98% in the 3rd quartile and 27.07% in the highest quartile. The most common insurance in the BMT+ CU+ population was Medicaid (32.78%), and in the BMT+ CU- population was Medicare (41.37%). On analysis of various outcomes in both cohorts, hospitalizations in the BMT+ CU- cohort were poorer as compared to the BMT+ CU+ cohort, with mortality being 4.67% in BMT+ CU- vs. 1.67% in BMT+ CU+. Similarly, in BMT+ CU- vs. BMT+ CU+ cohorts, transfusion prevalence was higher (13.09% vs. 8.89%), sepsis was higher (18.16% vs 14.44%), and septic shock was also higher (5.95% vs. 2.78%). Adjusted odds ratios (aORs) of various outcomes in BMT+ CU+ when compared to BMT+ CU- hospitalizations were calculated, which revealed lower aORs in patients with BMT+ CU+. The aOR of mortality in BMT+CU+ when compared to BMT+ CU- was 0.38 (95% CI 0.17-0.86, p=0.021). Similarly, aOR of transfusions was lower in BMT+ CU+ when compared to BMT+ CU- at 0.69 (95% CI 0.47-0.99, p=0.049). Additionally, aOR of septic shock was lower in BMT+ CU+ when compared to BMT+ CU- at 0.49 (95% CI 0.26-0.92, p=0.027). Conversely, the aOR of bleeding was higher in BMT+ CU+ than in BMT+ CU- at 2 (95% CI 1.22-3.26, p=0.005).

Conclusion

Our study underscores the association of CU with better outcomes such as mortality, transfusions, and septic shock in patients undergoing bone marrow transplantation while also highlighting the increased bleeding risk. Future studies are warranted to further understand this association of CU and various outcomes in this vulnerable and immunocompromised population of BMT patients.