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Andersen S, Fichera R, Banks M, Brown T, Kennedy G, Weber N, Williams D, Bauer J. Proactive enteral nutrition for patients undergoing allogeneic stem cell transplantation- implementation and clinical outcomes. Eur J Clin Nutr 2024; 78:251-256. [PMID: 37968417 DOI: 10.1038/s41430-023-01367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 10/21/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND/ OBJECTIVES Nutrition support is frequently required post allogeneic haematopoietic progenitor cell transplantation (HPCT) however the tolerance of enteral nutrition (EN) can vary. This mixed methods study aimed to explore staff perceptions, barriers and enablers to the use of EN post HPCT and report the implementation and outcomes of a nutrition protocol. SUBJECT/ METHODS A survey on barriers and enablers to the use of EN was developed and distributed to medical and nursing staff. Data on nutrition and clinical outcomes was collected for 12 months post implementation of a new nutrition protocol. RESULTS Thirty staff completed the survey, key barriers identified included uncertain EN tolerance, lack of confidence in nasogastric tube placement and insufficient training and resources. Eighty-four patients commenced EN, 23 changed to PN (27%) and 61 received EN only (73%). In total 36 patients received PN and eight patients oral nutrition support only. There was a difference in type of conditioning (p = 0.025) and nutritional status (p = 0.016) between patients who received PN vs EN only, with a higher proportion of malnourished patients receiving PN (23% vs 5%). Patients who received PN had a longer length of hospital stay (median 22 vs 19 days, p = 0.012) and lower rate of survival to day 100 (81% vs 95%, p = 0.036) than patients who received EN. CONCLUSION The use of EN may lead to improved clinical outcomes compared to PN therefore should be implemented as first line nutrition support.
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Affiliation(s)
- Sarah Andersen
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia.
- Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia.
| | - Rebecca Fichera
- Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - Merrilyn Banks
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
- Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
- Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - Glen Kennedy
- Department of Clinical Haematology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - Nicholas Weber
- Department of Clinical Haematology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - David Williams
- Department of Clinical Haematology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia
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Andersen S, Xu J, Llewellyn S, Kennedy G, Bauer J. Nutrition support and clinical outcomes following allogeneic stem cell transplantation. Bone Marrow Transplant 2023; 58:1137-1142. [PMID: 37542189 DOI: 10.1038/s41409-023-02080-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
Nutrition support is frequently required post allogeneic stem cell transplantation (SCT) and while there is some evidence on the benefits of enteral nutrition (EN), parenteral nutrition (PN) is widely used in practice. The study aimed to examine the impact of EN versus PN on early outcomes following SCT. All patients who underwent allogeneic SCT over 2.5 years were included in the analysis. Data was retrospectively collected on mode of nutrition support with clinical outcome data obtained from an existing database. Clinical outcomes were compared between groups by logistic, poisson and negative binomial regression, with adjustment for baseline confounders as appropriate. Patients who received EN then changed to PN had a longer length of hospital stay compared to those who received EN only (IR 1.24, 95% CI: 1.11-1.38, p < 0.001). Compared to those who received EN only, patients who received EN that changed to PN or PN only had a longer time to neutrophil engraftment (IR 1.11, 95% CI: 1.02-1.20, p = 0.016 and IR 1.16, 95% CI: 1.03-1.30, p = 0.017) and platelet engraftment (IR 1.20, 95% CI 1.08-1.33, p < 0.001 and IR 1.24, 95% CI 1.08-1.42, p = 0.002). Enteral nutrition should be first line nutritional support for patients undergoing allogeneic SCT.
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Affiliation(s)
- Sarah Andersen
- Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Jiani Xu
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Stacey Llewellyn
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - Glen Kennedy
- Department of Haematology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
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Cioce M, Botti S, Lohmeyer FM, Galli E, Magini M, Giraldi A, Garau P, Celli D, Zega M, Sica S, Bacigalupo A, De Stefano V, Borrelli I, Moscato U. Nutritional status and quality of life in adults undergoing allogeneic hematopoietic stem cell transplantation. Int J Hematol 2022; 116:266-275. [PMID: 35532878 PMCID: PMC9314297 DOI: 10.1007/s12185-022-03351-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/07/2023]
Abstract
Although the effects of malnutrition on morbidity and mortality in adult patients undergoing allogeneic hematopoietic stem cell transplantation are clear, the relationship with quality of life (QOL) is less clear. The purpose of this study was to assess the relationship between malnutrition and QOL. A prospective observational study was conducted in 36 adult patients undergoing allogeneic hematopoietic stem cell transplantation. Adapted criteria of the Global Leadership Initiative on malnutrition have been used for the diagnosis of malnutrition in clinical settings. A cancer linear analog scale was used to assess QOL. Overall QOL at 14 days after allogeneic hematopoietic stem cell transplantation was 37.1 (95% CI 2.9–45.39) in patients without severe malnutrition, versus 16.0 (95% CI − 6.6 to 38.6) in patients with severe malnutrition (p = 0.05). At discharge, it was 48.0 (95% CI 38.4–57.6) versus 34.0 (95% CI 4.1–63.9) (p = 0.27). The results of our study suggest that patients with severe malnutrition at discharge tend to have worse QOL. A larger cohort of patients is required to confirm this hypothesis.
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Affiliation(s)
- Marco Cioce
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Stefano Botti
- Haematology Unit, Oncology and Advanced Technology Department, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Eugenio Galli
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Marinella Magini
- UOC Clinical Nutrition, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Giraldi
- UOC Clinical Nutrition, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paola Garau
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Danilo Celli
- Faculty of Medicine and Psychology, Università "La Sapienza", Rome, Italy
| | - Maurizio Zega
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Simona Sica
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy.
| | - Andrea Bacigalupo
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan Borrelli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Moscato
- Department of Health Science of Woman and Child and Public Health-Occupational Health and Hygiene, Area-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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4
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Zama D, Gori D, Muratore E, Leardini D, Rallo F, Turroni S, Prete A, Brigidi P, Pession A, Masetti R. Enteral versus Parenteral Nutrition as Nutritional Support after Allogeneic Hematopoietic Stem Cell Transplantation: a Systematic Review and Meta-Analysis. Transplant Cell Ther 2020; 27:180.e1-180.e8. [PMID: 33830034 DOI: 10.1016/j.jtct.2020.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/31/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
Nutritional support for patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been widely debated. Enteral nutrition (EN) is recommended as first-line nutritional support by the main international guidelines. However, these recommendations are based on weak evidence, and there is wide variability in the types of nutritional support among transplantation centers, with the majority providing parenteral nutrition (PN) instead of EN. Here we provide an up-to-date systematic review and meta-analysis of studies comparing EN and PN for nutritional support during the neutropenic period after allo-HSCT. The literature search strategy identified 13 papers, of which 10 compared clinical transplantation outcomes, 2 compared gut microbiota (GM) compositions, and 1 compared systemic metabolic profiles. For the meta-analysis, among the 10 clinical studies, 8 studies in which 2 groups were compared were selected: in 1 group, EN was provided as primary nutritional support in the neutropenic phase after allo-HSCT with or without the addition of PN (EN group), whereas in the other group, only PN was provided as nutritional support. The incidence rates of acute graft-versus-host disease (aGVHD) (relative risk [RR], 0.69; 95% confidence interval [CI], 0.56 to 0.86; P = .0007), aGVHD grade III-IV (RR, 0.44; 95% CI, 0.30 to 0.64; P < .0001), and gut aGVHD (RR, 0.44; 95% CI, 0.30 to 0.66; P < .0001) were lower in the EN group than in the PN group. No differences were found between the 2 groups with regard to the incidence of severe oral mucositis (RR, 0.95; 95% CI, 0.83 to 1.09; P = .46) or overall survival at day +100 (RR, 1.07; 95% CI, 0.95 to 1.21; P = .29). Other variables were too heterogeneous to perform quantitative analyses. The results of the meta-analysis showed that EN reduced the incidence of aGVHD, specifically grade III-IV and gut aGVHD. This result should prompt improved efforts to implement EN as first-line nutritional support in patients undergoing allo-HSCT. Considering the emerging evidence regarding the association between GM dysbiosis and aGVHD onset, we speculate that this protective effect could be attributed to the improved gut eubiosis observed in enterally fed patients. Further studies are warranted to better address the relationship between the GM composition, aGVHD, and the nutritional administration route during HSCT.
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Affiliation(s)
- Daniele Zama
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Edoardo Muratore
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy.
| | - Davide Leardini
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Flavia Rallo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Silvia Turroni
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Patrizia Brigidi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
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5
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Andersen S, Weber N, Kennedy G, Brown T, Banks M, Bauer J. Tolerability of proactive enteral nutrition post allogeneic haematopoietic progenitor cell transplant: A randomised comparison to standard care. Clin Nutr 2020; 39:1364-1370. [DOI: 10.1016/j.clnu.2019.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/07/2019] [Accepted: 06/13/2019] [Indexed: 01/09/2023]
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Nutrition support during allogeneic stem cell transplantation: evidence versus practice. Support Care Cancer 2020; 28:5441-5447. [DOI: 10.1007/s00520-020-05397-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
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Barban JB, Simões BP, Moraes BDGDC, da Anunciação CR, da Rocha CS, Pintor DCQ, Guerra DC, Silva DA, Brandão EDCM, Kerbauy F, Pires FRDO, Morais GL, Schmidt J, Sicchieri JMF, Barroso KSN, Viana LV, da Rocha MHM, Guimarães MP, Lazzari NLC, Hamerschlak N, Ramos PP, Gomes PN, Mendonça PDS, de Oliveira RC, Scomparim RC, Chiattone R, Diez-Garcia RW, Cardenas TDC, Miola TM, Costa TCDM, Rocha V, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults. EINSTEIN-SAO PAULO 2020; 18:AE4530. [PMID: 32049129 PMCID: PMC6999189 DOI: 10.31744/einstein_journal/2020ae4530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.
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Affiliation(s)
- Juliana Bernardo Barban
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazil Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Belinda Pinto Simões
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Bruna Del Guerra de Carvalho Moraes
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Daniela Cristina Querino Pintor
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daiane Cristina Guerra
- Centro de Transplante de Medula ÓsseaInstituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazil Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | | | - Edith de Castro Martins Brandão
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Fábio Kerbauy
- Universidade Federal de São PauloSão PauloSPBrazil Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Jayr Schmidt
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Juliana Maria Faccioli Sicchieri
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Karine Sampaio Nunes Barroso
- Universidade Federal do CearáHospital Universitário Walter CantídioFortalezaCEBrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
| | - Luciana Verçoza Viana
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrazilHospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Mariana Hollanda Martins da Rocha
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Nelson Hamerschlak
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Plinio Patricia Ramos
- Hospital Leforte LiberdadeSão PauloSPBrazil Hospital Leforte Liberdade, São Paulo, SP, Brazil.
| | - Plinio Nascimento Gomes
- Centro de Transplante de Medula ÓsseaInstituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazil Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | - Priscila da Silva Mendonça
- Universidade Federal do CearáHospital Universitário Walter CantídioFortalezaCEBrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
| | | | - Renata Corrêa Scomparim
- Universidade Estadual de CampinasCampinasSPBrazilUniversidade Estadual de Campinas, Campinas, SP, Brazil.
| | - Ricardo Chiattone
- Hospital SamaritanoSão PauloSPBrazilHospital Samaritano, São Paulo, SP, Brazil.
| | - Rosa Wanda Diez-Garcia
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Thais Manfrinato Miola
- A.C.Camargo Cancer CenterSão PauloSPBrazil A.C.Camargo Cancer Center, São Paulo, SP, Brazil.
| | - Thalita Cristina de Mello Costa
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Vanderson Rocha
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Andrea Z Pereira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Woods T, Tariman JD, Lee YM. Enteral and Parenteral Nutrition: An Integrative Literature Review on Nutrition in Pediatric Recipients of Hematopoietic Stem Cell Transplantation. Clin J Oncol Nurs 2019; 23:351-354. [PMID: 31322627 DOI: 10.1188/19.cjon.351-354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides a summary of an integrative review on the efficacy of enteral nutrition (EN) and parenteral nutrition (PN) for meeting the nutrition and energy needs of pediatric patients following hematopoietic stem cell transplantation (HSCT). In addition, recommendations for clinical practice and research on nutrition supplementation for pediatric patients post-HSCT are included.
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Baumgartner A, Hoskin K, Schuetz P. Optimization of nutrition during allogeneic hematologic stem cell transplantation. Curr Opin Clin Nutr Metab Care 2018; 21:152-158. [PMID: 29465425 DOI: 10.1097/mco.0000000000000461] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Malnutrition before and during hematopoietic stem cell transplantation (HSCT) is an independent risk factor for mortality in patients undergoing hematopoietic stem cell transplantation. Yet, optimal use of nutritional support to improve outcomes remains controversial. Our aim was to do an up-to-date literature review regarding nutritional therapy in allogeneic HSCT, the neutropenic diet and the use of immunonutrients. RECENT FINDINGS Several observational studies find malnutrition to be associated with poor outcome, increased complications and lower overall survival. There are, however, few interventional trials proving the benefits of nutritional therapy in this population compared with no nutritional treatment. Regarding routes of treatment, studies suggested that parenteral nutrition is associated with higher risk for complications compared with enteral nutrition. Whether the use of specific formulas, such as immunonutrition, has a beneficial effect on clinical outcome is not established yet. Strict use of neutropenic diets did not show a reduction in infection risk and clinical outcome, and can no longer be recommended. SUMMARY Our updated search confirms that malnutrition is a strong negative predictor for outcome, yet optimal use of nutritional interventions to prevent or treat malnutrition remains ill-defined. There is need for larger randomized trials to better address these issues in the future.
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Revisiting nutritional support for allogeneic hematologic stem cell transplantation-a systematic review. Bone Marrow Transplant 2017; 52:506-513. [PMID: 28067888 DOI: 10.1038/bmt.2016.310] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
Abstract
In 2009, the American Society of Parenteral and Enteral Nutrition and its European counterpart (Euopean Society for Parenteral and Enteral Nutrition) published guidelines regarding nutritional support of patients with hematologic stem cell transplantation. Our aim was to do an up-to-date literature review regarding benefit of nutritional interventions and treatment recommendations. We searched MEDLINE, EMBASE and Cochrane Library for interventional and observational clinical studies. We extracted data based on a predefined case report form and assessed bias. Out of 459 potential abstracts, 13 studies of mostly moderate quality with a total of 18 167 patients were included. Two very large trials reported negative associations of malnutrition and survival, transplant-related mortality and relapse risk. Some trials found enteral nutrition (EN) to be as effective as parenteral nutrition (PN) with lower complication rates. In addition, EN was associated with better survival, less acute GvHD and faster neutrophil recovery. A neutropenic diet was not superior regarding overall survival, but in contrast resulted in higher infection risk. Current moderate quality studies show negative associations of malnutrition and clinical outcomes, with EN being superior to PN. There was no benefit of neutropenic diets. Large, randomized controlled studies are needed to better understand optimal nutritional support in this patient population.
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