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Gandossi C, Jessop H, Hahn A, Heininger L, Henes J, Radaelli AM, Carmagnola A, Morello E, Renica C, Bertulli A, Lazzari L, Kenyon M, Alexander T, Domenech A, Greco R. Nutritional aspects in autoimmune diseases undergoing hematopoietic stem cell transplantation: overview and recommendations on behalf of the EBMT ADWP and Nurses Group. Front Nutr 2024; 11:1394518. [PMID: 38784130 PMCID: PMC11111942 DOI: 10.3389/fnut.2024.1394518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Autoimmune diseases (ADs) represent a heterogeneous group of conditions affecting 5-10% of the global population. In recent decades, hematopoietic stem cell transplant (HSCT), mainly autologous, has been successfully adopted to treat patients affected by severe/refractory ADs. In this context malnutrition has a detrimental impact on relapse, mortality, infection rate, engraftment, long-term survival, and prolongation of hospitalization. However, in this population, the management of nutrition should be improved since nutritional assessment is partially performed in routine clinical practice. A panel of nurses and physicians from the European Society for Blood and Marrow Transplantation (EBMT) reviewed all available evidence based on current literature and expert practices from centers with extensive experience in HSCT for ADs, on the nutritional management of ADs patients during HSCT procedure. In this context, adequate nutritional status predicts a better response to treatment and improves quality of life. Herein, a systematic and comprehensive monitoring of nutritional status before, during and after HSCT, with adequate nutritional support in the case of ADs patients, in addition to assessing the dietary requirements associated with HSCT has been covered. Moreover, given the singularity of each AD, the underlying disease should be considered for an appropriate approach. The management and evaluation of nutritional status must be carried out by a multidisciplinary team to assess the needs, monitor the effectiveness of each intervention, and prevent complications, especially in complex situations as patients affected by ADs.
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Affiliation(s)
- Chiara Gandossi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Helen Jessop
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Anne Hahn
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa Heininger
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Jörg Henes
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Alexia Marina Radaelli
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Carmagnola
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Morello
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Renica
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alice Bertulli
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Lazzari
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michelle Kenyon
- Department of Haematology, King's College Hospital, London, United Kingdom
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ariadna Domenech
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Raffaella Greco
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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2
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Estran S, Loschi M, Benachour S, Soldati A, Chiche E, Sammut R, Robert G, Jacquel A, Chibois J, Schneider S, Cluzeau T. Improving nutritional status after allogeneic stem cell transplantation: results of phase 2 ALLONUT clinical trial. Bone Marrow Transplant 2024:10.1038/s41409-024-02271-w. [PMID: 38509196 DOI: 10.1038/s41409-024-02271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Malnutrition increases the risk of non-relapse mortality after allogeneic stem cell transplantation (aHSCT). Here are the results of the ALLONUT clinical trial designed to improve the nutritional outcome of patients receiving aHSCT. ALLONUT is a prospective open label phase 2 clinical trial assessing the efficacy of a close tailored nutritional support and management with traditional and original solutions to improve patients nutritional status following aHSCT. Nutritional status evaluation was performed before transplantation, on Day 0, 30, 100 and one year after transplantation. The study involved 70 patients treated by aHSCT. 10% of patients were moderately or severely malnutrition at baseline and 26.9 were severely malnutrition at D30. Patients' nutritional status improved thanks to the cooking classes and the personalized outpatient nutrition program. At D100, 23% were still malnutrition, while only 10.8% were severely malnutrition one year after transplantation. The QLQ-C30 show that quality of life (QoL) decreased until D30, and improve to reach the pre-transplant level on D100 before exceeding it on D360. The study confirmed that a close, personalized nutritional program combining traditional and original measures can improve both nutritional status and QoL for patients suffering from moderate or severe malnutrition after aHCST.
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Affiliation(s)
- Sophie Estran
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Michael Loschi
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France
| | - Sami Benachour
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Alizée Soldati
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Edmond Chiche
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Rinzine Sammut
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Guillaume Robert
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France
| | - Arnaud Jacquel
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France
| | | | - Stephane Schneider
- Nutrition department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Thomas Cluzeau
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France.
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France.
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3
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Bulthuis MS, van Gennip LLA, Bronkhorst EM, Blijlevens NMA, Huysmans MCDNJM, van Leeuwen SJM, Thomas RZ. The effect of hematopoietic stem cell transplantation on patient-reported subjective oral dryness: a systematic review focusing on prevalence, severity and distress. Support Care Cancer 2023; 31:449. [PMID: 37421511 PMCID: PMC10329604 DOI: 10.1007/s00520-023-07921-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The aim of the present systematic review is to assess the prevalence and severity of and distress caused by xerostomia over time in adult hematopoietic stem cell transplantation (HSCT) recipients. METHODS PubMed, Embase, and the Cochrane Library were searched for papers published between January 2000 and May 2022. Clinical studies were included if patient-reported subjective oral dryness was reported in adult autologous or allogeneic HSCT recipients. Risk of bias was assessed according to a quality grading strategy published by the oral care study group of the MASCC/ISOO, resulting in a score between 0 (highest risk of bias) and 10 (lowest risk of bias). Separate analysis focused on autologous HSCT recipients, allogeneic HSCT recipients receiving a myeloablative conditioning (MAC), and those receiving a reduced intensity conditioning (RIC). RESULTS Searches yielded 1792 unique records; 22 studies met the inclusion criteria. The quality scores ranged between 1 and 7, with a median score of 4. The prevalence, severity, and distress of xerostomia increased shortly after HSCT. Severity of xerostomia in allogeneic MAC recipients was higher compared to allogeneic RIC recipients 2-5 months post-HSCT (mean difference: 18 points on 0-100 scale, 95% CI: 9-27); after 1-2 years, there was no significant difference anymore. CONCLUSION The prevalence of xerostomia in HSCT recipients is high in comparison to the general population. The severity of complaints is raised during the first year post-HSCT. The intensity of the conditioning plays a key role in the short-term development of xerostomia, while factors affecting the recovery in the long term remain largely unknown.
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Affiliation(s)
- Marjolein S Bulthuis
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Lucky L A van Gennip
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Renske Z Thomas
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
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4
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Nutrition support use and clinical outcomes in patients with multiple myeloma undergoing autologous stem cell transplant. Support Care Cancer 2022; 30:9341-9350. [DOI: 10.1007/s00520-022-07358-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022]
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Schaffrath J, Diederichs T, Unverzagt S, Wass M, Gläser U, Weber T, Binder M, Müller-Tidow C, Müller LP. Correlation of nutrition-associated parameters with non-relapse mortality in allogeneic hematopoietic stem cell transplantation. Ann Hematol 2021; 101:681-691. [PMID: 34932150 PMCID: PMC8810470 DOI: 10.1007/s00277-021-04736-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/06/2021] [Indexed: 12/21/2022]
Abstract
Outcome of allogeneic stem cell transplantation (alloSCT) is hampered by substantial non-relapse mortality (NRM). Given its impact on organ function and immune response, the nutritional status has been suggested as relevant for NRM. We aimed to evaluate the association of NRM with nutritional status prior to alloSCT and in the post-SCT course. In a retrospective single-center study, we analyzed 128 alloSCTs. Besides standard characteristics, nutrition-associated parameters BMI, serum total protein, and serum albumin were recorded before conditioning and at various time points after alloSCT. Association with NRM was evaluated by univariate and multivariate survival analysis. The cohort comprised patients with a median BMI of 26 kg/m2 (16.7–46.9 kg/m2), median serum total protein of 59 g/l (41–77 g/l), and serum albumin of 36 g/l (22–46 g/l) before SCT. NRM at d+100 was 14.8% and at 1 year 26.6%. Prior to SCT, only serum albumin deficiency was associated with increased NRM (p = .010) in multivariate analysis. After SCT (d+30 and d+100), all nutrition-associated parameters decreased (p < .002), but no association of deteriorating nutritional status with NRM was found. In multivariate analysis, serum albumin (p = .03) and severe albumin deficiency (p = .02) correlated with NRM at d+30 and d+100, while BMI and serum total protein did not. In our study, albumin deficiency, particularly prior to alloSCT, shows a strong correlation with NRM. This finding may add to monitoring, risk evaluation, and counseling of patients and serve as a rational for interventions to improve the nutritional status in patients undergoing SCT.
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Affiliation(s)
- Judith Schaffrath
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Tanja Diederichs
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Nutrition, Consumption and Health, Faculty of Natural Science, University Paderborn, Paderborn, Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Maxi Wass
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ulrike Gläser
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Weber
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Lutz P Müller
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Botti S, van der Werf S, Stringer J, Eeltink C, Murray J, Ciceri F, Babic A, Duarte RF, Labopin M, Peczynski C, Basak GW, Liptrott SJ. Nutritional support in stem cell transplantation programs: Results from a multicenter survey of nurses on behalf of the Nurses Group and Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation and the Gruppo Italiano Trapianto di Midollo Osseo. Nutrition 2020; 79-80:110998. [PMID: 32987334 DOI: 10.1016/j.nut.2020.110998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/08/2020] [Accepted: 08/15/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Malnutrition in patients undergoing hematopoietic stem cell transplant (HSCT) can develop rapidly without appropriate nutritional support and affect morbidity and mortality. Guidance to monitor and manage nutrition status is described within the literature; however, whether this is applied in clinical practice is unclear. METHODS This paper describes a cross-sectional survey to explore current practice approaches in nutrition support management and adherence to international guidelines. RESULTS A total of 108 nurses from 108 centers across 16 countries replied to the questionnaire. A significant variation was observed regarding the availability of documents supporting the monitoring and management of nutrition status, application of recommendations, and nutritional practices. DISCUSSION The findings revealed that country was the most important factor influencing the differences in practice; however, significant differences were also observed based on patient age group (pediatrics vs. adults), department composition (hematology + HSCT unit vs. HSCT unit alone), and availability of nutrition health care professionals. Behavioral differences regarding nutritional practice approaches could be indicative of differences in knowledge or subject awareness, as well as a reflection of diversity across health care system policies. CONCLUSIONS Guideline dissemination and raising awareness through educational campaigns are suggested approaches to improve health care professionals' knowledge and sensitivity to this important topic.
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Affiliation(s)
- Stefano Botti
- Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy.
| | | | - Jacqui Stringer
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Corien Eeltink
- Cancer Center Amsterdam, Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - John Murray
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Aleksandra Babic
- Hemato-Oncology Unit, IOSI-Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Rafael F Duarte
- Hematopoietic Transplantation and Hemato-Oncology Section, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Myriam Labopin
- Department of Hematology and Cell Therapy and EBMT Paris Office, Hôpital Saint-Antoine APHP, Saint Antoine, France
| | - Christophe Peczynski
- Department of Hematology and Cell Therapy and EBMT Paris Office, Hôpital Saint-Antoine APHP, Saint Antoine, France
| | - Grzegorz Wladyslaw Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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7
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Kneis S, Straub E, Walz ID, von Olshausen P, Wehrle A, Gollhofer A, Bertz H. Gait Analysis of Patients After Allogeneic Hematopoietic Cell Transplantation Reveals Impairments of Functional Performance. Integr Cancer Ther 2020; 19:1534735420915782. [PMID: 32368937 PMCID: PMC7236089 DOI: 10.1177/1534735420915782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: After allogeneic hematopoietic cell transplantation
(alloHCT), patients often report functional impairments like reduced gait speed
and muscle weakness. These impairments can increase the risk of adverse health
events similar to elderly populations. However, they have not been quantified in
patients after alloHCT (PATs). Methods: We compared fear of falling
(Falls Efficacy Scale–International) and temporal gait parameters recorded on a
10-m walkway at preferred and maximum gait speed and under dual-task walking of
16 PATs (aged 31-73 years) with 15 age-matched control participants (CONs) and
17 seniors (SENs, aged >73 years). Results: Groups’ gait
parameters especially differed during the maximum speed condition: PATs walked
slower and required more steps/10 m than CONs. PATs exhibited greater stride,
stance, and swing times than CONs. PATs’ swing time was even longer than SENs’.
The PATs’ ability to accelerate their gait speed from preferred to fast was
smaller compared with CONs’. PATs reported a greater fear of falling than CONs
and SENs. Conclusion: Gait analysis of alloHCT patients has
revealed impairments of functional performance. Patients presented a diminished
ability to accelerate gait and extending steps possibly related to a notable
strength deficit that impairs power-generation abilities from lower extremities.
Furthermore, patients reported a greater fear of falling than control
participants and even seniors. Slowing locomotion could be a risk-preventive
safety strategy. Since functional disadvantages may put alloHCT patients at a
higher risk of frailty, reinforcing appropriate physical exercises already
during and after alloHCT could prevent adverse health events and reduce the risk
of premature functional aging.
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Affiliation(s)
- Sarah Kneis
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
| | - Elisa Straub
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
- Department of Psychology, University of
Freiburg, Freiburg, Germany
| | - Isabelle Daniela Walz
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
| | - Philipp von Olshausen
- Currently at Fraunhofer Institute for
Physical Measurement Techniques IPM, Freiburg, Germany
| | - Anja Wehrle
- Institute for Exercise- and Occupational
Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University
of Freiburg, Freiburg, Germany
- Department of Sport and Sport Science,
University of Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science,
University of Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
- Hartmut Bertz, Department of Medicine I,
Medical Centre—University of Freiburg, Hugstetterstr 55, Freiburg 79106,
Germany.
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8
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Guderyon MJ, Chen C, Bhattacharjee A, Ge G, Fernandez RA, Gelfond JAL, Gorena KM, Cheng CJ, Li Y, Nelson JF, Strong RJ, Hornsby PJ, Clark RA, Li S. Mobilization-based transplantation of young-donor hematopoietic stem cells extends lifespan in mice. Aging Cell 2020; 19:e13110. [PMID: 32012439 PMCID: PMC7059148 DOI: 10.1111/acel.13110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 12/25/2022] Open
Abstract
Mammalian aging is associated with reduced tissue regeneration and loss of physiological integrity. With age, stem cells diminish in their ability to regenerate adult tissues, likely contributing to age-related morbidity. Thus, we replaced aged hematopoietic stem cells (HSCs) with young-donor HSCs using a novel mobilization-enabled hematopoietic stem cell transplantation (HSCT) technology as an alternative to the highly toxic conditioning regimens used in conventional HSCT. Using this approach, we are the first to report an increase in median lifespan (12%) and a decrease in overall mortality hazard (HR: 0.42, CI: 0.273-0.638) in aged mice following transplantation of young-donor HSCs. The increase in longevity was accompanied by reductions of frailty measures and increases in food intake and body weight of aged recipients. Young-donor HSCs not only preserved youthful function within the aged bone marrow stroma, but also at least partially ameliorated dysfunctional hematopoietic phenotypes of aged recipients. This compelling evidence that mammalian health and lifespan can be extended through stem cell therapy adds a new category to the very limited list of successful anti-aging/life-extending interventions. Our findings have implications for further development of stem cell therapies for increasing health and lifespan.
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Affiliation(s)
| | - Cang Chen
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
| | | | - Guo Ge
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
| | - Roman A. Fernandez
- Department of Epidemiology and BiostatisticsUT Health San AntonioSan AntonioTXUSA
| | | | - Karla M. Gorena
- Flow Cytometry Core FacilityUT Health San AntonioSan AntonioTXUSA
| | - Catherine J. Cheng
- Department of Cell Systems and AnatomyUT Health San AntonioSan AntonioTXUSA
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
| | - Yang Li
- Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - James F. Nelson
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of Cellular and Integrative PhysiologyUT Health San AntonioSan AntonioTXUSA
| | - Randy J. Strong
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of PharmacologyUT Health San AntonioSan AntonioTXUSA
- Research ServiceSouth Texas Veterans Health Care SystemSan AntonioTXUSA
| | - Peter J. Hornsby
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of Cellular and Integrative PhysiologyUT Health San AntonioSan AntonioTXUSA
| | - Robert A. Clark
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
- Research ServiceSouth Texas Veterans Health Care SystemSan AntonioTXUSA
| | - Senlin Li
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of PharmacologyUT Health San AntonioSan AntonioTXUSA
- Research ServiceSouth Texas Veterans Health Care SystemSan AntonioTXUSA
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9
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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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10
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Prediction of clinical outcome by controlling nutritional status (CONUT) before allogeneic hematopoietic stem cell transplantation in myeloid malignancies. Int J Hematol 2019; 110:599-605. [DOI: 10.1007/s12185-019-02723-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
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11
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Ferreira MH, Mello Bezinelli L, de Paula Eduardo F, Lopes RM, Pereira AZ, Hamerschlack N, Corrêa L. Association of oral toxicity and taste changes during hematopoietic stem cell transplantation: a preliminary study. Support Care Cancer 2019; 28:1277-1287. [PMID: 31236700 DOI: 10.1007/s00520-019-04922-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to characterize the taste changes and taste bud atrophy observed in the period of neutropenia of HCT and to determine the influence of transplantation toxicity on these changes. METHODS Autologous and allogeneic HCT patients (n = 51) were selected to perform taste acuity tests prior to conditioning (T0) and during neutropenia (T1). The frequency and time duration of oral mucositis, presence of tongue depapillation, and salivary flow rate were also evaluated. Quality of life was assessed using specific questionnaires. RESULTS We observed a significant increase in hypogeusia (66.6%, p = 0.001) and dysgeusia (21.4%, p = 0.013) at T1, compared with T0. Bitter taste was the most altered, mainly when the patient underwent conditioning with melphalan (OR = 4.47, p = 0.049). Prolonged oral mucositis (≥ 8 days) (OR = 5.62, p = 0.039) and autologous transplantation (OR = 4.08, p = 0.033) were predictive factors for tongue depapillation. Changes in sour taste (OR = 10.70, p = 0.045) and reduced salivary flow (OR = 21.00, p = 0.013) were associated to body weight loss at T1. Taste changes significantly reduced the quality of life at T1, compared with T0. CONCLUSIONS Frequency of hypogeusia was high in the neutropenia period of the HCT. None of the taste changes was determined by oral mucositis, tongue depapillation, or reduced salivary flow, but melphalan conditioning reduced the bitter taste sensation. Loss of body weight and poor quality of life were associated with taste changes and reduced salivary flow. Further studies are necessary to elucidate this association and the risk factors for taste changes in HCT.
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Affiliation(s)
- Mariana Henriques Ferreira
- Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- General Pathology Department, School of Dentistry, University of São Paulo, 2227 Cidade Universitária, São Paulo, 05508-000, Brazil
| | | | | | - Roberta Marques Lopes
- Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrea Z Pereira
- Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nelson Hamerschlack
- Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luciana Corrêa
- General Pathology Department, School of Dentistry, University of São Paulo, 2227 Cidade Universitária, São Paulo, 05508-000, Brazil.
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12
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Gonçalves SEAB, Ribeiro AAF, Hirose EY, Santos FPDS, Ferreira FM, Koch LDOM, Tanaka M, de Souza MS, Souza PMR, Gonçalves TJM, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly. EINSTEIN-SAO PAULO 2019; 17:eAE4340. [PMID: 31116236 PMCID: PMC6533077 DOI: 10.31744/einstein_journal/2019ae4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
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Affiliation(s)
| | - Andreza Alice Feitosa Ribeiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Centro de Transplante de Medula Óssea, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Márcia Tanaka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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13
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Epstein JB, de Andrade e Silva SM, Epstein GL, Leal JHS, Barasch A, Smutzer G. Taste disorders following cancer treatment: report of a case series. Support Care Cancer 2019; 27:4587-4595. [DOI: 10.1007/s00520-019-04758-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
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14
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Chemosensory changes and quality of life in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer 2018; 26:3553-3561. [PMID: 29704111 DOI: 10.1007/s00520-018-4200-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/09/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess magnitude and characteristics of changes in chemosensory function and quality of life (QOL) for patients receiving hematopoietic stem cell transplantation (HSCT). METHODS Patients (aged 18 years and above) scheduled to undergo HSCT at the Seattle Cancer Care Alliance were tested for chemosensory function at three time points: pre-transplant (baseline), 30 ± 5 days (day 30), and 80 ± 5 days (day 80) post-HSCT. Gustatory function was assessed following procedures developed at the Monell-Jefferson Taste and Smell Clinic. Olfactory testing was conducted using the National Institute of Health Toolbox Odor Identification test. QOL was also assessed. RESULTS Twenty-nine patients were enrolled in the study between August 2014 and March 2015. Twenty-three patients were included in the analysis, with 16 tested at all three time points (baseline, day 30, and day 80). The primary finding is decreased taste sensitivity for 0.32 M NaCl, 0.0056 M citric acid, and 0.018 M citric acid on day 30 following HSCT. Increased taste sensitivity for 0.32 M sucrose at day 30 was also observed. Taste sensitivity largely recovered by day 80. Olfactory identification scores were unchanged from baseline to day 30. QOL was reduced at day 30 but was restored to an acceptable level of functioning and symptoms by day 80. However, some areas remain impaired. CONCLUSIONS Alterations in taste perception were confirmed in the early post-transplant period. This was largely resolved within 2.5 months. No obvious impairments were observed in olfactory function. QOL improved by day 80, though some oral symptoms lingered.
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15
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Prevalence of malnutrition in adult patients previously treated with allogeneic hematopoietic stem-cell transplantation. Clin Nutr 2018; 37:739-745. [DOI: 10.1016/j.clnu.2017.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 12/16/2022]
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16
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Peric Z, Botti S, Stringer J, Krawczyk J, van der Werf S, van Biezen A, Aljurf M, Murray J, Liptrott S, Greenfield DM, Duarte RF, Ruutu T, Basak GW. Variability of nutritional practices in peritransplant period after allogeneic hematopoietic stem cell transplantation: a survey by the Complications and Quality of Life Working Party of the EBMT. Bone Marrow Transplant 2018. [PMID: 29515252 DOI: 10.1038/s41409-018-0137-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recommendations on screening and nutritional support for patients undergoing hematopoietic stem cell transplantation (HSCT) have been presented by international nutritional societies, but nutritional practices remain poorly standardized. Following the general policy of the European Society for Blood and Marrow Transplantation (EBMT) to standardize transplantation procedures, the Complications and Quality of Life Working Party and Nursing Research Group carried out a survey among all EBMT centers about their current nutritional practices. The aim of this study was to better understand current practices, differences from available guidelines, and possible barriers for recommended nutritional therapy. Responses from 90 centers (19%) from 23 countries were received. We observed a marked variability in nutritional care between EBMT centers and a substantial lack of standardized operating procedures in screening patients for malnutrition and management of gastrointestinal GVHD. Furthermore, our study confirmed neutropenic diet as standard of care in most centers as well a preference for parenteral nutritional support over enteral. On the basis of these findings, future EBMT efforts will focus on better implementation of international nutritional guidelines into clinical practice.
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Affiliation(s)
- Zinaida Peric
- Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Stefano Botti
- Hematology Unit, Oncology Department, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Jacqui Stringer
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Joanna Krawczyk
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - John Murray
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | | | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Tapani Ruutu
- Clinical Research Institute, Helsinki University Hospital, Helsinki, Finland
| | - Grzegorz W Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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17
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Nutritional risk in allogeneic stem cell transplantation: rationale for a tailored nutritional pathway. Ann Hematol 2017; 96:617-625. [DOI: 10.1007/s00277-016-2910-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/23/2016] [Indexed: 12/26/2022]
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Rodgers C. Weight Gain and Height Velocity in Young Children 1 Year Following Bone Marrow Transplant: A Single Institution Study. J Pediatr Oncol Nurs 2016; 21:358-63. [PMID: 15475473 DOI: 10.1177/1043454204269607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The nutritional and growth effects on children following a bone marrow transplant (BMT) have not been well documented. The purpose of this study was to describe the growth patterns of young children during the first year following BMT. A retrospective chart review was used to examine the nutritional status of 25 young children, 1 to 6 years of age, who received an allogeneic BMT. Nutritional data were reviewed prior to BMT and at 3, 6, 9, and 12 months following BMT. The mean weight gain was 2.5 kg with a median weight gain of 2.3 kg (range, -1.2 to 9.4 kg). The mean height gain was 7 cm with a median height gain of 7.4 cm (range, 1.2 to 16.8 cm). Growth related to gender, age, and incidence of infection was similar to the overall average; however, children with graft-versus-host disease revealed poor weight and height gain. Nurses must learn to recognize patients at nutritional risk and intervene when necessary. More research is needed to address specific nutritional needs of the pediatric BMT patient.
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Affiliation(s)
- Cheryl Rodgers
- Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, Houston, USA.
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19
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Pre-transplant arm muscle area: a simple measure to identify patients at risk. Support Care Cancer 2015; 23:3385-91. [DOI: 10.1007/s00520-015-2850-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/06/2015] [Indexed: 02/06/2023]
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20
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Botti S, Liptrott SJ, Gargiulo G, Orlando L. Nutritional support in patients undergoing haematopoietic stem cell transplantation: a multicentre survey of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) transplant programmes. Ecancermedicalscience 2015; 9:545. [PMID: 26180544 PMCID: PMC4494819 DOI: 10.3332/ecancer.2015.545] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
A survey within Italian haematopoietic stem cell transplant (HSCT) programmes was performed, in order to obtain a snapshot of nutritional support (NS) in patients undergoing HSCT. The primary objective was to verify whether an evidence-based practice (EBP) approach to NS was implemented in HSCT centres. A multicentre survey was performed by questionnaire, covering the main areas of NS (screening, treatment planning, monitoring, nutritional counselling, and methods of nutritional support). The results indicated a significant variation between clinical practice and evidence-based guidelines in terms of clinical pathways, decision-making, and care provision regarding NS. Further research is required to identify reasons for the limited application of EBP and measures that may be undertaken to address such issues. Development of a multidisciplinary educational programme in order to raise awareness of the issue should be undertaken.
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Affiliation(s)
- Stefano Botti
- Complex Operational Unit of Haematology, ASMN-IRCCS Reggio Emilia, viale Risorgimento 80, Reggio Emilia 42123, Italy
| | - Sarah Jayne Liptrott
- Division of Haemato-oncology, European Institute of Oncology, via Ripamonti 435, Milan 20141, Italy
| | - Gianpaolo Gargiulo
- Bone Marrow Transplant Centre, AOU Federico II, via S. Pansini 5, Naples 80131, Italy
| | - Laura Orlando
- Division of Haemato-oncology, European Institute of Oncology, via Ripamonti 435, Milan 20141, Italy
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21
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Lemal R, Cabrespine A, Pereira B, Combal C, Ravinet A, Hermet E, Bay JO, Bouteloup C. Could enteral nutrition improve the outcome of patients with haematological malignancies undergoing allogeneic haematopoietic stem cell transplantation? A study protocol for a randomized controlled trial (the NEPHA study). Trials 2015; 16:136. [PMID: 25872934 PMCID: PMC4391165 DOI: 10.1186/s13063-015-0663-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/19/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Myeloablative allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a major procedure usually accompanied by multifactorial malnutrition, prompting the recommendation of systematic artificial nutritional support. Parenteral nutrition (PN) is usually administered during allo-HSCT, essentially for practical reasons. Recently published data suggest that enteral nutrition (EN), given as systematic artificial nutrition support, could decrease grade III-IV graft-versus-host disease (GVHD) and infectious events, which are associated with early toxicity after allo-HSCT and then have an impact on early transplant-related mortality (D100 mortality). METHODS/DESIGN We report on the NEPHA trial: an open-label, prospective, randomised, multi-centre study on two parallel groups, which has been designed to evaluate the effect of EN compared to PN on early toxicity after an allo-HSCT procedure. Two hundred forty patients treated with allo-HSCT for a haematological malignancy will be randomly assigned to two groups to receive either EN or PN. The primary endpoint will assess the effect of EN on D100 mortality. Secondary endpoints will compare EN and PN with regards to the main haematological, infectious and nutritional outcomes. DISCUSSION The impacts of nutritional support should exceed the limits of nutritional status improvement: EN may directly reduce immunological and infectious events, as well as decrease early transplant-related morbidity and mortality. EN and PN need to be prospectively compared in order to assess their impacts and to provide treatment guidelines. (Clinical trials gov number: NCT01955772; registration: July 19th, 2013).
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Affiliation(s)
- Richard Lemal
- CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003, Clermont-Ferrand, France. .,Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000, Clermont-Ferrand, France.
| | - Aurélie Cabrespine
- CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003, Clermont-Ferrand, France. .,Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000, Clermont-Ferrand, France.
| | - Bruno Pereira
- CHU Clermont-Ferrand, Unité biostatistique Direction de la Recherche Clinique, F-63003, Clermont-Ferrand, France.
| | - Cécile Combal
- CHU Clermont-Ferrand, Service Diététique, F-63003, Clermont-Ferrand, France.
| | - Aurélie Ravinet
- CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003, Clermont-Ferrand, France. .,Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000, Clermont-Ferrand, France.
| | - Eric Hermet
- CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003, Clermont-Ferrand, France. .,Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000, Clermont-Ferrand, France.
| | - Jacques-Olivier Bay
- CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003, Clermont-Ferrand, France. .,Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000, Clermont-Ferrand, France.
| | - Corinne Bouteloup
- CHU Clermont-Ferrand, Service de Médecine Digestive et Hépatobiliaire, F-63003, Clermont-Ferrand, France. .,Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000, Clermont-Ferrand, France. .,INRA, UMR 1019, UNH, CRNH Auvergne, F-63000, Clermont-Ferrand, France.
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22
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Rodgers CC, Krance R, Street RL, Hockenberry MJ. Symptom prevalence and physiologic biomarkers among adolescents using a mobile phone intervention following hematopoietic stem cell transplantation. Oncol Nurs Forum 2014; 41:229-36. [PMID: 24769589 DOI: 10.1188/14.onf.229-236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE/OBJECTIVES To examine symptom reports and physiologic parameters in adolescents using the Eating After Transplant (EAT!) intervention during recovery after hematopoietic stem cell transplantation (HSCT). DESIGN Repeated measures design. SETTING HSCT service at a pediatric teaching institution in the southern United States. SAMPLE 16 adolescents recovering from a first-time allogeneic HSCT. METHODS Use of EAT! was monitored electronically, symptom reports were obtained from a questionnaire, and physiologic parameters were obtained from the medical record at HSCT hospital discharge and 20, 40, and 60 days postdischarge. MAIN RESEARCH VARIABLES EAT! use, symptom prevalence, symptom-related distress, and physiologic parameters including weight, body mass index (BMI), pre-albumin, and albumin. FINDINGS Symptom prevalence was highest at hospital discharge and steadily declined; however, mean symptom distress scores remained stable. Mean weight and BMI significantly declined during the first 60 days postdischarge; pre-albumin and albumin markers were unchanged. No correlation was noted among use of EAT! and any research variables. CONCLUSIONS The most frequent symptoms were not always the most distressing symptoms. Weight and BMI significantly declined during HSCT recovery. IMPLICATIONS FOR NURSING Nurses should assess symptom frequency and distress to fully understand patients' symptom experiences. Nurses should monitor weight and BMI throughout HSCT recovery.
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Affiliation(s)
| | | | - Richard L Street
- Department of Communication, Texas A&M University in College Station
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Dreyer J, Schwartz-Attias I. Nursing care for adolescents and young adults with cancer: literature review. Acta Haematol 2014; 132:363-74. [PMID: 25228562 DOI: 10.1159/000360213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cancer patients belonging to the adolescent and young adult (AYA) age group have unique and very specific needs, which require special attention from the caring staff. The difficulty in maintaining the personal and professional development at this age is both natural and normal. Adding to this, coping with a life-threatening disease turns this stage in life into a period with many dilemmas and challenges of quite a complex nature. AYA patients have to deal with issues above and beyond the disease itself, which create a very complex coping picture. On top of that, prognosis for this age group has not improved in recent years, unlike the situation in other age groups like children and adults. The literature on this subject is extensive and comprehensive. However, most of the papers on this subject are very specific and narrow in their approach, each dealing with a specific topic. In this article, we bring together many different papers which make a wide and comprehensive picture of the subject of AYAs coping with cancer, coupled with recommendations for the caring staff. In this review we focus on the various aspects of the disease and treatments in AYAs, based on the conceptual model of quality of life proposed by Ferrell and colleagues [Cancer Nurs 1992;15:153-160; Cancer Nurs 1992;15:247-253], including physical, social, emotional and spiritual aspects. From the psychological standpoint, most of the papers discuss the negative aspects; however, in this article we try to include some articles from the positive psychology school of thought. From our findings it is apparent that there is an opportunity and need to further explore research in this regard. It is apparent that taking a unique approach to AYA cancer patients is needed in order to deal with the unique needs of this age group. This article aims at putting a framework around this issue, with actionable recommendations for the caring staff.
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Affiliation(s)
- Juliet Dreyer
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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24
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25
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Black G. Haemato-Oncology. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Bozzetti F. Nutritional support of the oncology patient. Crit Rev Oncol Hematol 2013; 87:172-200. [DOI: 10.1016/j.critrevonc.2013.03.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/28/2013] [Accepted: 03/06/2013] [Indexed: 01/06/2023] Open
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27
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Hung YC, Bauer J, Horsley P, Waterhouse M, Bashford J, Isenring E. Changes in nutritional status, body composition, quality of life, and physical activity levels of cancer patients undergoing autologous peripheral blood stem cell transplantation. Support Care Cancer 2013; 21:1579-86. [DOI: 10.1007/s00520-012-1698-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/20/2012] [Indexed: 12/22/2022]
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28
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Daudt LE. Comment on: clinical impact of systematic nutritional care in adults submitted to allogeneic hematopoietic stem cell transplantation. Rev Bras Hematol Hemoter 2012; 34:325-6. [PMID: 23125535 PMCID: PMC3486817 DOI: 10.5581/1516-8484.20120083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 11/27/2022] Open
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Urbain P, Birlinger J, Lambert C, Finke J, Bertz H, Biesalski HK. Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2012; 48:446-51. [DOI: 10.1038/bmt.2012.158] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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So EJ, Lee JS, Kim JY. Nutritional intake and nutritional status by the type of hematopoietic stem cell transplantation. Clin Nutr Res 2012; 1:3-12. [PMID: 23430590 PMCID: PMC3572806 DOI: 10.7762/cnr.2012.1.1.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to investigate the changes of nutritional intake and nutritional status and analyze the association between them during hematopoietic stem cell transplantation. This was a retrospective cross sectional study on 36 patients (9 Autologous transplantation group and 27 Allogeneic transplantation group) undergoing hematopoietic stem cell transplantation at The Catholic University of Korea, Seoul St. Mary's Hospital from May to August 2010. To assess oral intake and parenteral nutrition intake, 24-hour recall method and patient's charts review was performed. Nutritional status was measured with the scored patient-generated subjective global assessment (PG-SGA). The subjects consisted of 6 (66.7%) males and 3 (33.3%) females in the autologous transplantation group (auto), 12 (44.4%) males and 15 (55.6%) females in the allogeneic transplantation group (allo). The mean age was 40.9 ± 13.6 years (auto) and 37.8 ± 11.0 years (allo). The average hospitalized period was 25.2 ± 3.5 days (auto) and 31.6 ± 6.6 days (allo), which were significant different (p < 0.05). Nutritional intake was lowest at Post+1wk in two groups. In addition, calorie intake by oral diet to recommended intake at Post+2wk was low (20.8% auto and 20.5% allo) but there were no significant differences in change of nutritional intake over time (Admission, Pre-1day, Post+1wk, Post+2wk) between auto group and allo group by repeated measures ANOVA test. The result of nutritional assessment through PG-SGA was significantly different at Pre-1day only (p < 0.01). There was a significant negative correlation between the nutritional status during Post+2wk and the oral calorie/protein intake to recommended amount measured during Post+1wk and Post+2wk (p < 0.01). These results could be used to establish evidence-based nutritional care guidelines for patients during hematopoietic stem cell transplantation.
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Affiliation(s)
- Eun Jin So
- Department of Nutrition, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, Korea
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Zatarain L, Savani BN. The role of nutrition and effects on the cytokine milieu in allogeneic hematopoietic stem cell transplantation. Cell Immunol 2012; 276:6-9. [DOI: 10.1016/j.cellimm.2012.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/10/2012] [Indexed: 12/28/2022]
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Durrieu J, Blanc-Bisson C, Fonck M, Béchade D, Becouarn Y, Blanc JF, Ceccaldi J, Chomy F, Houédé N, Lécaille C, Smith D, Soubeyran P, Terrebonne E, Vergnol J, Bourdel-Marchasson I. Huit fiches pratiques de conseil nutritionnel pour répondre aux besoins des patients âgés au cours de leur traitement de chimiothérapie: étude INOGAD. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1985-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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What to eat when off treatment and living with involuntary weight loss and cancer: a systematic search and narrative review. Support Care Cancer 2010; 19:1-17. [DOI: 10.1007/s00520-010-0964-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
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Rodgers C, Young A, Hockenberry M, Binder B, Symes L. The meaning of adolescents' eating experiences during bone marrow transplant recovery. J Pediatr Oncol Nurs 2010; 27:65-72. [PMID: 20176916 DOI: 10.1177/1043454209355984] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Bone marrow transplant (BMT) is a common treatment option for adolescents with various diseases; however, the aggressive therapy often causes significant side effects that can lead to poor eating. There is little documentation of eating experiences and necessary support needed after the initial BMT hospitalization. This phenomenological study, guided by Martin Heidegger's philosophical influences, revealed the meaning of adolescents' eating experiences, eating strategies, and the impact of eating on the adolescents' quality of life during the first 100 days post-BMT. Individual interviews were conducted at 50 and 100 days post-BMT. Data analysis used the hermeneutic circle and revealed 5 themes. Adolescents discussed the slow return of eating, barriers that affected their eating, personal eating strategies, significance of eating, and feelings regarding eating. Eating issues do not end when a BMT patient is discharged from the hospital, and caregivers need to have a better understanding of the ongoing issues affecting adolescents throughout the BMT recovery phase.
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Cohen J, Maurice L. Adequacy of Nutritional Support in Pediatric Blood and Marrow Transplantation. J Pediatr Oncol Nurs 2009; 27:40-7. [DOI: 10.1177/1043454209345362] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The use of nutrition support has become standard practice in blood and marrow transplantation, but what remains unclear is whether patients receive adequate nutrition supplementation during this time. This study is a retrospective audit of the nutritional supplementation of 34 pediatric patients admitted to a pediatric oncology unit for a blood and marrow transplantation. All patients received parenteral nutrition (PN) as their standard nutritional therapy with an average of 79 ± 10.6% of their estimated requirements given over the transplant period. The glucose/amino acid infusion was inadequate on 40% of PN days mainly because of fluid overload causing a reduction in infusion rates. The lipid infusion was inadequate on 60% of PN days mainly because of stoppages when drugs and/or blood were infused. The mean percentage weight change on discharge was +0.3 ± 4.7%. This had a large range of between −9.9% and +7.9% of body weight and did not seem to be related to adequacy of nutrition during transplant. This study showed that although frequent rate reductions in nutrition infusions did occur, most patients still received the majority of their nutritional requirements.
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Affiliation(s)
- Jennifer Cohen
- Centre for Children's Cancer & Blood Disorders, Sydney Children's Hospital, Randwick,
| | - Lucy Maurice
- Centre for Children's Cancer & Blood Disorders, Sydney Children's Hospital, Randwick
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August DA, Huhmann MB. A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr 2009; 33:472-500. [PMID: 19713551 DOI: 10.1177/0148607109341804] [Citation(s) in RCA: 301] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- David Allen August
- Department of Surgery, Division of Surgical Oncology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
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Abstract
The field of high-dose therapy and SCT has made many advances in the past several years and the success rates have been steadily increasing as newer therapies emerge and improvements in supportive care continue to improve patient survival and cure rates. There still remains a mortality risk for high-dose therapy and the need for palliative care becomes more apparent as the focus also incorporates quality of life in all facets of cancer treatment and care. This paper reports on the lack of literature available on palliative care into the BMT and explores areas of future research in the integration of these two fields of medicine.
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Affiliation(s)
- H M Chung
- Department of Internal Medicine, Division of Hematology/Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
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Rodgers C, Walsh T. Nutritional Issues in Adolescents After Bone Marrow Transplant: A Literature Review. J Pediatr Oncol Nurs 2008; 25:254-64. [DOI: 10.1177/1043454208321115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bone marrow transplantation and related complications can cause gastrointestinal (GI) side effects that can lead to poor nutrition, which has been associated with several morbidity and mortality issues. Adolescents require adequate nutrition not only to maintain health but to advance with normal growth and development. This article synthesizes the bone marrow transplant (BMT) literature regarding adolescents' nutritional needs, etiologies of altered oral intake, GI symptoms, nutritional assessments, nutritional interventions, and quality of life associated with poor nutrition. In addition, gaps in knowledge in the literature are identified. To provide effective and thorough care to patients during their BMT recovery, the knowledge base of nutritional and eating issues after transplant needs to become more comprehensive. Nurses play an important role in gathering and reporting clinical information. By anticipating potential risk factors, assessing and identifying symptoms, and initiating appropriate interventions promptly, patients can experience a more positive BMT experience.
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Affiliation(s)
| | - Teresa Walsh
- College of Nursing, Texas Women's University, Houston, Texas
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Prise en charge nutritionnelle lors d’une chimiothérapie pour hémopathie maligne. NUTR CLIN METAB 2003. [DOI: 10.1016/s0985-0562(03)00053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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