Effect of malnutrition-driven nutritional support protocol on clinical outcomes in autologous stem cell transplantation patients

Lazarow, Heather; Singer, Ryan; Compher, Charlene; Gilmar, Cheryl; Kucharczuk, Colleen; Mangan, Patricia; Salam, Kelly; Cunningham, Kathleen; Stadtmauer, Edward A.; Landsburg, Daniel J.

doi:10.1007/s00520-020-05571-1

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Similar findings can be seen in reviews of adult literature regarding malnutrition and nutritional support during BMT [ 58 , 59 ]. In a trial of adults who underwent autologous BMT, a nutrition optimization protocol that featured early initiation of EN and targeted PN was associated with a decreased rate of infections, as well as shorter LOS [ 58 ]. There was no difference in time to platelet engraftment, and overall survival was not measured past day +30 [ 58 ].…”

Section: Discussionsupporting

confidence: 86%

“…In a trial of adults who underwent autologous BMT, a nutrition optimization protocol that featured early initiation of EN and targeted PN was associated with a decreased rate of infections, as well as shorter LOS [ 58 ]. There was no difference in time to platelet engraftment, and overall survival was not measured past day +30 [ 58 ]. Hirose et al [ 59 ] found that severe malnutrition in adult patients prior to the start of allogeneic BMT was associated with a higher risk of acute GVHD, increased non-relapse mortality, and decreased OS, illustrating that there is a role for optimization of nutritional status, even before the patient is admitted for BMT.…”

Section: Discussionmentioning

confidence: 99%

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Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review

Murphy,

Symons,

Cooke

2024

Children

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Nutrition is vital to the long-term survival of children undergoing blood and marrow transplantation (BMT), but there is no standardization on how to optimize the nutritional status of these patients. A literature search was performed to evaluate nutritional support approaches currently in practice for pediatric patients who are undergoing BMT. CINAHL, Embase, and Cochrane databases were searched for peer-reviewed articles evaluating nutritional interventions for BMT recipients aged 20 or younger. Nine articles published between 2019 and 2023 were found and reviewed. The nutritional support varied between enteral nutrition, parenteral nutrition, a combination of both, and prophylactic feeding tube placement. The post-transplant outcomes identified as associated with alterations in nutritional regimens included length of stay, date of platelet engraftment, incidence of acute graft-versus-host disease, infection rate, and overall survival. The use of any amount of enteral nutrition compared to parenteral alone was beneficial. Complications during BMT can potentially be decreased via prioritizing enteral nutrition over parenteral. The paucity of literature on this topic highlights an unmet need in the field. Future research should focus on ways to optimize the nutritional support of transplant recipients, including increasing the likelihood of enteral feeding tube placement and utilization.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review

Murphy,

Symons,

Cooke

2024

Children

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“…Three hundred sixty-two of these patients were included in a previous publication. 13 The complete patient list was cross-referenced with a list of patients with CLABSI maintained by the hospital Department of Infection Control and Prevention. This analysis was approved as a quality improvement project by the Institutional Review Board at the University of Pennsylvania.…”

Section: Methodsmentioning

confidence: 99%

“…12 In our previous prospective cohort study of 508 autologous stem-cell transplant patients, a nutritional support protocol that included PN for malnourished patients was associated with decreased odds of CLABSI. 13 Large randomized controlled trials in the intensive care unit setting using modern practices have demonstrated no difference in risk of infection in patients receiving PN compared with those receiving enteral nutrition (EN). [14][15][16] Incidence of CLABSI in hematologic oncology patients receiving PN with modern practices deserves further investigation because of the role of malnutrition in clinical outcomes for this population.…”

Section: Introductionmentioning

confidence: 99%

Central Line–Associated Bloodstream Infection in Patients With Hematologic Malignancy Receiving Parenteral Nutrition

Lazarow

Compher

Ziegler

et al. 2023

JCO Oncology Practice

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PURPOSE Parenteral nutrition (PN) has been shown to be a safe method of feeding in the intensive care unit with modern infection prevention practices, but similar analysis in the hematology-oncology setting is lacking. METHODS A retrospective analysis of 1,617 patients with hematologic malignancies admitted and discharged from the Hospital of the University of Pennsylvania during 3,629 encounters from 2017 to 2019 was undertaken to evaluate the association of PN administration with risk of central line–associated bloodstream infection (CLABSI). Proportions of mucosal barrier injury (MBI)-CLABSI and non–MBI-CLABSI were also compared between groups. RESULTS Risk of CLABSI was associated with cancer type and duration of neutropenia but not with PN administration (odds ratio, 1.015; 95% CI, 0.986 to 1.045; P = .305) in a multivariable analysis. MBI-CLABSI comprised 73% of CLABSI in patients exposed to and 70% in patients not exposed to PN, and there was no significant difference between groups (χ2 = 0.06, P = .800). CONCLUSION PN was not associated with increased risk of CLABSI in a sample of patients with hematologic malignancy with central venous catheters when adjusting for cancer type, duration of neutropenia, and catheter days. The high proportion of MBI-CLABSI highlights the effect of gut permeability within this population.

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The HSCT procedure (II): Conditioning, hematopoietic stem cell infusion, supportive care, and monitoring

Raiola,

Ghiso,

Gambella

et al. 2024

Handbook of Clinical Neurology

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Effect of malnutrition-driven nutritional support protocol on clinical outcomes in autologous stem cell transplantation patients

Cited by 6 publications

References 25 publications

Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review

Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review

Central Line–Associated Bloodstream Infection in Patients With Hematologic Malignancy Receiving Parenteral Nutrition

The HSCT procedure (II): Conditioning, hematopoietic stem cell infusion, supportive care, and monitoring

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