Examination of a nutritional treatment pathway according to pretreatment health status and stress levels of patients undergoing hematopoietic stem cell transplantation

Abstract

Introduction This study aimed to validate hematopoietic stem cell transplantation (HSCT) treatment via a tailored nutritional pathway in myeloablative conditioning (MAC), determine its efficacy in terms of remission, and explore associations between clinical outcomes and nutritional indicators. Methods We included patients who underwent MAC for HSCT at the Shizuoka Cancer Center Stem Cell Transplantation between 2015 and 2019. We evaluated outcomes from the day before treatment initiation (transplant date: day 0) to day 42. Results Among the 40 MAC cases (participant characteristics: 20/40 males, mean age of 52 years, and mean body mass index of 21.9 kg/m2), we found that the percent loss of body weight and loss of skeletal muscle mass were correlated with the basal energy expenditure rate (BEE rate; r = 0.70, p<0.001 and r = 0.49, p<0.01, respectively). Based on the receiver operating characteristics curves, the cutoff value for the BEE rate in terms of weight loss was 1.1. Salivary amylase levels did not significantly change during the treatment course. Continuous variables, including oral caloric intake and performance status, showed statistically significant correlations with nutrition-related adverse events during treatment (r = −0.93, p<0.01 and r = 0.91, p<0.01, respectively). Skeletal muscle mass before treatment initiation was an independent predictive variable for reduced 2-year survival (p = 0.04). Conclusion Our results support the validity of a safe nutritional pathway with a BEE rate of 1.1 for HSCT patients pretreated with MAC. Specifically, we found that this pathway could prevent weight loss in response to nutrition-related adverse events. Skeletal muscle mass before treatment was identified as an independent risk factor for reduced 2-year survival.

The effect of oral nutrition supplement (ONS) on the nutritional and clinical status of patients undergoing autologous hematopoietic stem cell transplantation: study protocol for a randomized controlled clinical trial

“…Studies have highlighted that weight loss within the first 100 days post-HSCT influences short-term clinical outcomes and one-year overall survival [ 37 ]. Additionally, a tailored nutritional pathway with a specific basal energy expenditure rate has been validated to prevent weight loss in HSCT patients undergoing myeloablative conditioning, with skeletal muscle mass identified as an independent risk factor for reduced 2-year survival [ 38 ]. In addition, malnutrition was linked to a slower recovery, greater rates of readmission, and increased death following HSCT [ 7 ].…”

The Critical Exploration into Current Evidence behind the Role of the Nutritional Support in Adult Patients Who Undergo Haematogenic Stem Cell Transplantation

“…Another indicator of impaired nutritional status as well as an indicator of the risk factor for HSCT survival rate is skeletal muscle measurement. However, a specialist, high-precision body composition analysis device is required for this examination [ 43 , 44 , 45 ].…”

Relationship Between Preoperative Nutritional Indices and Sarcopenia in Patients With Stage III Colorectal Cancer

“…4 , 5 However, their relationship with the muscle mass measurements obtained by body composition monitors and extremity measurements based has not yet been validated in patients with cancer. 6 - 8 In addition, no association between sarcopenia and nutritional assessment in stage III colorectal cancer has been reported. On the other hand, elevated inflammatory markers have been reported in malignant conditions.…”