HLA, GVHD, and parenteral nutrition are risk factors for hepatic complications in pediatric HSCT

Thorvaldson, Linda; Remberger, Mats; Winiarski, Jacek; Omazic, Brigitta; Fischler, Björn; Sundin, Mikael

doi:10.1111/petr.12623

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…By influencing both the extent and duration of PN use in HSCT, acute and delayed CINV may affect the risks of hepatobiliary toxicity and gut aGvHD. 4,5 Minimization of eating disruptions also is an important determinant of quality of life following transplant, at least in adolescents, 18 and maintenance of enteral intake may reduce mucositis severity. 6 Finally, improvement in complete CINV control may result in cost savings through reduction in PN use.…”

Section: Discussionmentioning

confidence: 99%

“…Through its effect on enteral intake, CINV in the HSCT population may also increase mucositis severity, increase the risk of hepatobiliary toxicity and increase gut acute GvHD (aGvHD) severity. [3][4][5][6] We have previously shown that complete chemotherapy-induced vomiting (CIV) control in pediatric HSCT patients is seldom achieved. 7 Nausea control in pediatric HSCT patients has never been evaluated using a validated tool.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The burden of chemotherapy-induced nausea and vomiting in children receiving hematopoietic stem cell transplantation conditioning: a prospective study

Flank

Sparavalo

Vol

et al. 2017

Bone Marrow Transplant

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This prospective study describes chemotherapy-induced nausea and vomiting (CINV) in children (4-18 years) receiving their first hematopoietic stem cell transplant. Emetic episodes, nausea severity (assessed using a validated, self-report nausea severity assessment tool) and antiemetic administration were documented from the start of conditioning until 24 h after the last conditioning agent was administered (acute) and for a further 7 days (delayed). Relationships between CINV control and parenteral nutrition (PN) use and acute gut GvHD (aGvHD) were explored. Fifty-nine children (4.6-17.4 years) were evaluable. Complete chemotherapy-induced vomiting (CIV; acute: 24%; delayed 22%) and chemotherapy-induced nausea (CIN; acute 7%; delayed 12%) control rates were low. Few children experienced complete CINV control (no vomiting/retching and no nausea) during the acute (5%) or delayed phases (12%). Children experiencing complete acute or delayed CIN control or complete delayed CIV control were more likely to have received: a lower proportion of their total energy requirement as PN at the end of the delayed phase (P<0.036) and PN for a shorter time (P<0.044). Low patient numbers did not permit evaluation of the association between gut aGvHD and CINV control. Effective and safe interventions aimed at improving CINV control in children are required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The burden of chemotherapy-induced nausea and vomiting in children receiving hematopoietic stem cell transplantation conditioning: a prospective study

Flank

Sparavalo

Vol

et al. 2017

Bone Marrow Transplant

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“…If clinically possible, the enteral route is preferred over the parenteral route in these patients [31,32]. An association between TPN, particularly soy-based lipid emulsions, and cholestatic disease has been established in other models of liver disease [33,34], and TPN has been associated with an increased risk of hepatobiliary dysfunction in children undergoing HCT [35]. Liver-sparing TPN protocols, including soy-based lipid minimization to <1 g/kg/day or temporary withholding of lipids, have been used [33].…”

Section: Q8 Are There Nutritional Guidelines For Children Who Develomentioning

confidence: 99%

Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplant Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents: Part 2—Focus on Ascites, Fluid and Electrolytes, Renal, and Transfusion Issues

Mahadeo

McArthur

Adams

et al. 2017

Biology of Blood and Marrow Transplantation

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Even though hepatic veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic cell transplantation (HCT), there is paucity of research on the management of associated multiorgan dysfunction. To help provide standardized care for the management of these patients, the HCT Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators and the Supportive Care Committee of the Pediatric Blood and Marrow Transplant Consortium, collaborated to develop evidence-based consensus guidelines. After conducting an extensive literature search, in part 2 of this series we discuss the management of fluids and electrolytes, renal dysfunction; ascites, pleural effusion, and transfusion and coagulopathy issues in patients with VOD. We consider the available evidence using the GRADE criteria.

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“…In pediatric patients, a total serum bilirubin ≥ 33 µmol/L one month after allo-HSCT has been associated with higher non-relapse mortality (24). HB seems more associated with mortality than hepatocellular injury, defined as elevated aminotransferase levels without HB in hematological patients (25).…”

Section: Introductionmentioning

confidence: 99%

The Burden of Hyperbilirubinemia in Critically Ill Patients with Hematological Malignancies: Post-hoc Analysis of a Prospective Multicenter Multinational Study

Bisbal¹,

Darmon²,

Saillard³

et al. 2020

Preprint

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BackgroundThe evidence on the clinical significance of hyperbilirubinemia (HB) in critically ill patients with hematological malignancies is scarce. We therefore studied its burden in a 2010-2011 Franco-Belgian multicenter prospective study designed to evaluate the prognosis of these patients.Patients and methodsThe cohort comprised 893 patients from 17 centers, 61% men, with a median (interquartile range) age of 60 (49 – 70) years, and preferentially with underlying non-Hodgkin lymphoma (32%) or acute myeloid leukemia (27%). HB was defined as a total serum bilirubin ≥ 33 µmol/L at intensive care unit (ICU) admission. Our main goal was to evaluate the relationship between HB and outcome of critically ill hematological patients. Causes and management of HB in the ICU were analyzed as secondary end points.ResultsHB concerned 185 (21%) patients. Cyclosporine and antimicrobial treatments, ascites and cirrhosis, acute kidney injury, neutropenia, and myeloma (adjusted odd ratio [aOR] 0.38, p=0.006) were risk factors. Hospital mortality was 56.3% and 36.3% in patients with and without HB, respectively (p<0.0001 with the log-rank test). Adjusted for severity of illness, the adjusted odds ratio (95% confidence interval) of HB for in-hospital mortality was 1.86 (1.28, 2.72). HB was overlooked by the ICU team for 92 (53%) patients. Overwise, liver workups for HB led to treatment modifications in 32 (40%) patients, including chemotherapy for cancer progression that was associated with reduced mortality with an adjusted odds ratio of 0.23, (p=0.02).ConclusionHB is associated with outcome of critically ill hematological adult patients and should be systematically explored and treated.

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HLA, GVHD, and parenteral nutrition are risk factors for hepatic complications in pediatric HSCT

Abstract: GVHD is an important risk factor for liver dysfunction post-HSCT. Specific HLA types may also contribute as a risk factor, while others seem to have a protective effect.

Cited by 9 publications

References 23 publications

The burden of chemotherapy-induced nausea and vomiting in children receiving hematopoietic stem cell transplantation conditioning: a prospective study

The burden of chemotherapy-induced nausea and vomiting in children receiving hematopoietic stem cell transplantation conditioning: a prospective study

The Burden of Hyperbilirubinemia in Critically Ill Patients with Hematological Malignancies: Post-hoc Analysis of a Prospective Multicenter Multinational Study

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