Nutritional assessment of peripheral blood stem cell transplantation in children

Nutritional Status of Hematological Patients before Hematopoietic Stem Cell Transplantation and in Early Posttransplantation Period

Hematopoietic stem cell transplantation (HSCT) is an aggressive method of treatment affecting patient's homeostasis. The aim of the study was to evaluate the initial nutritional status of HSCT patients and nutritional status in early posttransplantation period. The prospective study included 100 consecutive patients with hematological malignancies subjected to HSCT. The nutritional status evaluation was made using the nutritional screening scales, anthropometric and biochemical parameters, as well. On the day +7 following HSCT significant decrease in concentration of total protein (5.8 g/dl), albumin (3.6 g/dl) and transferrin (165 mg/dl) were observed (P < 0.001), although the mean body mass/BMI were within the normal range. On the day +14, the biochemical parameters of the nutritional status were even lower (P < 0.001). Poorer nutritional status was associated with worse performance status and mucositis escalation. The adequate nutritional support plan is important element of the whole transplantation procedure.

Non-surgical oncology - Guidelines on Parenteral Nutrition, Chapter 19

Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase.

Blood and marrow transplantation and nutritional support

INTRODUCTION

Undernourishment on hospital admission has been considered as risk factor for complications and increased relapse/nonrelapse mortality in hematopoietic stem cell transplantation (HSCT) patients.

MATERIALS AND METHODS

All patients undergoing HSCT are at an increased risk for malnutrition. The changes in these patients affect mainly protein, energy, and micronutrient metabolism. Nutrition support recommendations are now based on the nutritional status of the individual patient, and total parenteral nutrition is no longer indicated for all HSCT patients. As long as it is possible, an oral route should be use in feeding to avoid complications. When total parenteral nutrition (TPN) should be started is one of the most controversial issues. The following indications for TPN are now generally accepted: severe malnutrition at admission (BMI < 18.5) or weight loss > 10% during treatment or impossibility of oral feeding or failing to meet 60-70% of the requirements over 3 days. Specialized nutritional support containing glutamine or immunomodulatory formulas such as arginine, ω3 polyunsaturated fatty acids, purine/pyrimidines (RNA) may be useful.

RESULT

The complications of TPN are divided into metabolic and those related to central venous catheter. TPN should be progressively decreased while increasing feedings by the oral route. When the patients can cover ≥50% of the daily energy requirements orally (for greater than 5 days), withdrawal of TPN may be appropriate. In patients who have suffered from graft-versus-host disease (GvHD) with intestinal involvement, TPN should be used until the stool volume decreases to <500 ml/day for at least 2 days.

CONCLUSION

Parenteral nutrition allows better modulation of fluid, electrolytes, and nutrient administration which can be of critical importance when complications such as GvHD or VOD arise.

Biochemical indices for the assessment of nutritional status during hematopoietic stem cell transplantation: are they worth using? A single center experience

Hematopoietic stem cell transplantation (HSCT) is being used increasingly in an attempt to cure many hematological disorders, solid tumors and autoimmune diseases. One of the major challenges in the post-transplant period is nutrition. The purpose of this investigation was to assess changes in the biochemical indices of nutritional status during HSCT and compare them with acute-phase protein levels to find the best parameters for nutritional support qualification. Nutritional status was assessed in 54 patients during autologous (30 cases) and allogeneic (24 cases) transplantation. Fifteen patients had to be treated with total parenteral nutrition (TPN), eight of them needing prolonged hospitalization. All nutritional indices and acute-phase protein levels were evaluated during the day before the beginning of conditioning regimen, after chemotherapy completion and every 7 days until engraftment, at least three times after stem cells infusion. Wilcoxon test and canonical analysis were used for statistical analyses. The measurement of retinol-binding protein and transferrin can be useful for nutritional assessment during autologous and allogeneic HSCT, respectively. Prealbumin level, measured 8 days after the end of conditioning regimen, is helpful in making a decision about starting TPN.