Medical Nutritional Therapy in Hematopoietic Stem Cell Transplantation (HSCT)

Abstract

Hematopoietic Stem Cell Transplantation (HSCT) is a method used for the treatment of patients with severe aplastic anemia, leukaemia and some other malignancies. As it causes many adverse sequelaes (anorexia, nausea, vomiting, diarrhea, and mucositis), adequate oral diet is usually unachievable and artificial nutrition support is required. In order to reduce the risk of infections, the protective benefit of "low-microbial / neutropenic diets" is suggested to use in immunosuppressed patients. Traditionally, total parenteral nutrition (TPN) has been the chosen method for the nutritional support of patients undergoing HSCT. Secondly enteral nutrition (especially with enteral tube feeding -ETF) is an alternative method for nutritional support. It is important that dietary guidance for HSCT patients to minimize the risk of microbial exposure, optimize nutrient consumption and energy intake is very important.Keywords: Hematopoietic Stem Cell Transplantation, Nutrition, Neutropenic diet, Nutritional support ÖZET Hematopoietik Kök Hücre Transplantasyonu (HKHT)'nda T›bbi Beslenme TedavisiHematopoietik Kök Hücre Transplantasyonu (HKHT) a¤›r aplastik anemi, lösemi ve di¤er baz› maligniteleri olan hastalar›n tedavisi için kullan›lan bir yöntemdir. Hastal›k birçok yan etkilere (ifltahs›zl›k, bulant›, kusma, ishal ve mukozit) neden oldu¤undan, ço¤unlukla yeterli oral beslenme sa¤lanamamakta ve beslenme deste¤i gerekmektedir. Ba¤›fl›kl›¤› bask›lanm›fl hastalarda enfeksiyonlar›n riskini azaltmak için "düflük-mikrobiyal / nötropenik diyetler" koruyucu yarar sa¤lamas› nedeniyle önerilmektedir. Geleneksel olarak, HKHT uygulanan hastalarda total parenteral beslenme (TPN), beslenme deste¤i için seçilen yöntem olmufltur. ‹kinci bir yöntem olan enteral beslenme uygulamas› (özellikle enteral tüp ile beslenme -ETB), beslenme deste¤i için alternatif bir yöntemdir. HKHT hastalar›na yöne-lik oluflturulan diyet rehberlerinde, enfeksiyona maruz kalma riskini en aza indirgemek amac›yla optimal besin tüketimi ve enerji al›m› çok önemlidir.

Nutritional status of patients submitted to transplantation of allogeneic hematopoietic stem cells: a retrospective study

“…Impaired nutritional status is considered a negative prognostic factor in hospitalized patients and is associated with adverse clinical consequences. 7,10 …”

“…Some studies indicate that the nutritional status of the patient before transplantation can affect the prognosis, and the extremes (malnutrition and obesity) are related to higher mortality and more complications associated with transplantation. 7,10 In this scenario, specialized nutritional interventions may contribute to increased tolerance to chemotherapy and radiotherapy, contributing to the success of treatment. 9,12,26 …”

“…Patients submitted to allogeneic HSCT should be considered at nutritional risk 7–9 due to reduced energy intake, impaired absorption of nutrients and increased metabolic demands. 10…”

“…The adverse effects of chemotherapy and TBI affect, in particular, the gastrointestinal (GI) tract and the immune system. 7 Accordingly, in addition to symptoms of nausea and vomiting, severe mucositis associated with intense odynophagia, abdominal pain and diarrhea often occurs. 11,12 GI complications of the conditioning regimen may last for up to 21 days after transplantation.…”

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults

“…Patients undergoing HSCT can be considered as at nutritional risk, due to reduced calorie supply, impaired nutrient absorption, and increased metabolic demands, which may compromise the nutritional status of these patients throughout the process. (12,216,238,239) Thus, these patients are prone to developing multiple metabolic disorders of variable severity − mostly during the immediate post-transplant period. The main causes include adverse effects from the conditioning regimen, immunosuppressants and PNT.…”