Short-term follow-up of the nutritional status of children with Fanconi anemia undergoing hematopoietic stem cell transplant

Longitudinal clinical manifestations of Fanconi anemia: A systematized review

Fanconi anemia (FA) is a rare and complex inherited genetic disorder characterized by impaired DNA repair mechanisms leading to genomic instability. Individuals with FA have increased susceptibility to congenital anomalies, progressive bone marrow failure, leukemia and malignant tumors, endocrinopathies and other medical issues. In recent decades, steadily improved approaches to hematopoietic cell transplantation (HCT), the only proven curative therapy for the hematologic manifestations of FA, have significantly increased the life expectancy of affected individuals, illuminating the need to understand the long-term consequences and multi-organ ramifications. Utilizing a systematized review approach with narrative synthesis of each primary issue and organ system, we shed light on the challenges and opportunities for optimizing the care and quality of life for individuals with FA and identify knowledge gaps informing future research directions.

Protein intake and requirements in children and adolescents undergoing Hematopoietic Stem Cell Transplant (HSCT): An international benchmarking survey and a scoping review

BACKGROUND & AIMS

For children and adolescents undergoing hematopoietic stem cell transplant (HSCT), adequate protein and energy intake is essential to mitigate malnutrition risk. However, little is known about optimal requirements, including adequate dietary protein intake in this population. We conducted an international benchmarking survey and a scoping review to explore current practices in determining protein requirements (PR) and examine existing evidence for PR and dietary protein intake in pediatric HSCT.

METHODS

Twelve pediatric oncology centers were surveyed to elicit current practices in determining PR in pediatric HSCT. A scoping review then collected sources of evidence from six databases (MEDLINE, Embase, CINAHL, PubMed, Cochrane Library and Web of Science) and grey literature (Google Scholar).

RESULTS

Survey data revealed variable practices in determining PR for pediatric HSCT patients. Four centers (44%) used the American Society for Parenteral and Enteral Nutrition (ASPEN) Nutrition Support in Pediatric Critically Ill Patient Guidelines 2009 and four (44%) used local guidelines or their national nutrient reference values (NRV). The scoping review included nineteen studies. The review highlighted a broad range of PR used in this population, ranging from 0.8 to 3.0 g/kg/d. Practices regarding the documentation and frequency of collecting protein intake data varied. Only five studies reported estimated protein requirement (EPR) status and just two studies met EPR. No clinical guidelines on PR in pediatric HSCT were identified.

CONCLUSIONS

Given the existing gap in evidence, the optimal amount of protein required for children and adolescents undergoing HSCT remains unknown. To establish specific, evidence-based PR guidelines, comprehensive research is needed. Future investigations should prioritize evaluating current clinical practices, assessing the gap between actual protein intake and EPR, and understanding the relationship between protein intake, protein status, and the impact on treatment outcomes. Addressing these research priorities is crucial for bridging the current evidence gap, thereby enabling the development of enhanced and personalized nutritional support for children and adolescents undergoing HSCT.

[Advances in nutritional support for children undergoing hematopoietic stem cell transplantation]

Hematopoietic stem cell transplantation (HSCT) is a therapeutic option for various potentially life-threatening malignant and non-malignant diseases in children, such as malignancies, immunodeficiency syndromes, severe aplastic anemia, and inherited metabolic disorders. During transplantation, many factors can affect the nutritional status of the children, including radiotherapy, chemotherapy, gastrointestinal disorders, graft-versus-host disease, and medications. Malnutrition has been associated with decreased overall survival and increased complications in children undergoing HSCT, making nutritional support a crucial component of their management. However, currently, there is a lack of guidelines or consensus on nutritional support for children undergoing HSCT in China. Therefore, this review summarizes the progress in nutritional support for children undergoing HSCT, aiming to provide clinical guidance.

Weight loss in children undergoing allogeneic hematopoietic stem cell transplantation within the first 100 days: Its influencing factors and impact on clinical outcomes

Purpose/Objective

This study aimed to evaluate the nutritional status of children subjected to allogeneic hematopoietic stem cell transplantation (alloHSCT) in the first 100 days. Objectives were to clarify the effect of weight loss on clinical outcomes, and to analyze factors influencing weight loss.

Methods

Eighty pediatric patients receiving alloHSCT were enrolled in the study. Body mass index (BMI) z-scores and weight for age (WFA) z-scores were collected. A multivariate regression model was set up to investigate factors affecting weight loss. Post-transplant clinical outcomes relative to weight loss on 100 days after transplantation were analyzed.

Results

At admission, eight patients (10%) were underweight, the number had increased to 23 (30.67%) by 100 days post-HSCT. On day + 100, only nutrition screening tool for childhood cancer (SCAN) scores ≥ 3 (OR: 4.474, 95% CI: 1.215, 16.472; P = 0.024) and acute graft versus host disease (aGVHD) (OR: 9.915, 95% CI: 3.302, 29.771; P < 0.001) were regarded as significant influencing factors of weight loss. The Weight loss ≥ 5% group was associated with longer hospital stays (P = 0.001), greater cost of inpatient treatment (P = 0.001), and a higher incidence of 100-day re-admission and intensive care unit (ICU) transfer (P = 0.03 and P = 0.033, respectively). Cumulative number of fever days (P = 0.023) and antibiotic use (P = 0.007) also increased significantly. The Weight loss ≥ 5% group had a significantly lower one-year overall survival rate compared with the Weight loss < 5% group (P = 0.015).

Conclusion

Pediatric patients' nutritional status declined significantly after HSCT. Weight loss within the first 100 days influenced short-term clinical outcomes and one-year overall survival.

Mesenchymal stem cell markers in periodontal tissues and periapical lesions

INTRODUCTION

Mesenchymal stem cells (MSCs) are characterized by the potential to differentiate into multiple cell lineages, high proliferation rates, and self-renewal capacity, in addition to the ability to maintain their undifferentiated state. These cells have been identified in physiological oral tissues such as pulp tissue, dental follicle, apical papilla and periodontal ligament, as well as in pathological situations such as chronic periapical lesions (CPLs). The criteria used for the identification of MSCs include the positive expression of specific surface antigens, with CD73, CD90, CD105, CD44, CD146, STRO-1, CD166, NANOG and OCT4 being the most specific for these cells.

AIM

The aim of this review was to explore the literature on markers able to identify MSCs as well as the presence of these cells in the healthy periodontal ligament and CPLs, highlighting their role in regenerative medicine and implications in the progression of these lesions.

METHODS

Narrative literature review searching the PubMed and Medline databases. Articles published in English between 1974 and 2020 were retrieved.

CONCLUSION

The included studies confirmed the presence of MSCs in the healthy periodontal ligament and in CPLs. Several surface markers are used for the characterization of these cells which, although not specific, are effective in cell recognition. Mesenchymal stem cells participate in tissue repair, exerting anti- inflammatory, immunosuppressive and proangiogenic effects, and are therefore involved in the progression and attenuation of CPLs or even in the persistence of these lesions.