Nutrition Support in Bone Marrow Transplant Recipients

Herrmann, Virginia M.; Petruska, Paul J.

doi:10.1177/011542659300800119

Cited by 57 publications

(27 citation statements)

References 79 publications

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“…Nutrient needs were assessed at 1.3-1.5 times basal energy expenditure (using the Harris-Benedict equation 10 ) and 1.5-1.75 g of protein per kilogram body weight. 2 Adjusted body weight was used for calculating nutrient needs of patients significantly over ideal body weight. The following formula was used for adjusted body weight: ((actual weightÀideal weight) Â 0.25)+ideal weight ¼ adjusted body weight.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3] Most patients' oral intake is minimal for at least 2-3 weeks post transplant (posttx) and use of total parenteral nutrition (TPN) during this period is common. The preparative regimens utilized at our center typically result in significant pancytopenia and gastrointestinal (GI) toxicities, including mucositis, leading to the intuitive conclusion that TPN is necessary.…”

Section: Cancer; Nutritional Statusmentioning

confidence: 99%

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Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Roberts

Miller

Piñeiro

et al. 2003

Bone Marrow Transplant

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Summary:Autologous HCT patients often have poor oral intake for 2-4 weeks post transplant. To compare outcomes between patients provided prophylactic total parenteral nutrition (TPN) or an oral diet (OD), 55 well nourished breast cancer/ hematopoietic cell transplantation (HCT) patients were randomized to TPN (n ¼ 27), beginning day À1, or OD (n ¼ 28). Parameters studied include length of stay (LOS), engraftment, infections, survival, weight, anthropometrics, handgrip strength, and quality of life (QOL) In all, 50% of OD patients were given TPN due to poor oral intake for 10 consecutive days. No significant differences were found between the groups for any of the above parameters except weight and anthropometrics, which were better maintained in the TPN group than the OD group. Trends were seen for increased infections, more stable handgrip strength, and improved QOL in the TPN group vs the OD group. Prophylactic TPN did result in a more intact nutritional status and preservation of lean body mass post transplant but did not impact LOS or survival when compared to OD. For this reason, TPN should be reserved for autologous HCT patients with pretransplant nutritional depletion, complications post transplant, or prolonged poor oral intake. These results should not be extrapolated to allogeneic HCT patients but are likely applicable to other well nourished autologous HCT patients. The nutrition problems associated with high-dose chemotherapy and hematopoietic cell transplantation (HCT) are well known. 1-3 Most patients' oral intake is minimal for at least 2-3 weeks post transplant (posttx) and use of total parenteral nutrition (TPN) during this period is common. The preparative regimens utilized at our center typically result in significant pancytopenia and gastrointestinal (GI) toxicities, including mucositis, leading to the intuitive conclusion that TPN is necessary. Weisdorf et al 4 showed that provision of prophylactic TPN was beneficial to marrow transplant recipients. At the time our study was initiated, TPN was a standard of care posttx at our center. However, since HCT for breast cancer (CA) is relatively new, no breast CA patients were included in the aforementioned trial. Also, several advances have been made since that trial was conducted (cytokine growth factors and peripheral blood stem cell transplants), which have shortened the neutropenic period in this patient population, which, in turn, may lead to more rapid return to normal GI function. While currently the use of autologous HCT in breast CA is controversial and not currently carried out at our center, interest in HCT for breast CA still exists. [5][6][7][8] This study was carried out to compare clinical, and nutritional outcomes, as well as sense of well-being and survival, in breast CA patients undergoing HCT randomized to an oral diet vs prophylactic TPN. Patients and methodsA total of 55 females with stage II-IV breast CA undergoing high-dose chemotherapy and HCT were prospectively randomized to an oral diet (OD) (n ¼ 28) or TPN (n ¼ 27). Inst...

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Section: Methodsmentioning

confidence: 99%

Section: Cancer; Nutritional Statusmentioning

confidence: 99%

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Roberts

Miller

Piñeiro

et al. 2003

Bone Marrow Transplant

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“…Figure 2 shows that any weight and LBM loss experienced during the immediate post-BMT period is not regained during the first year. Negative nitrogen balance is common in patients in the immediate post-HSCT period 31 as a consequence of negative energy balance due to hyper- metabolism, intestinal losses with diarrhea and catabolic effects on skeletal muscle, initially exerted by the underlying disease, then by conditioning regimens, and subsequently by possible HSCT complications such as infection and GVHD. 29,30 Whereas weight and BF increased above baseline measurements by 2-3 years post-HSCT, the LBM remained below baseline levels up to 6 years post-BMT, and 38% of patients do not regain their pre-HSCT LBM at 4-6 years post-HSCT.…”

Section: Situation Before and After Hsctmentioning

confidence: 99%

Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

Kyle

Chalandon

Miralbell

et al. 2005

Bone Marrow Transplant

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Summary:Patients with hematological malignancies are well nourished prior to allogeneic hematopoietic stem cell transplantation (HSCT). HSCT and associated complications can affect body composition. The study evaluated crosssectionally the prevalence and longitudinally the changes in lean body mass index (LBMI) in HSCT patients. Patients (n ¼ 82) were classified as normal or low LBMI. Logistic regression analyses were used to estimate odds ratios (OR) for low vs normal LBMI, between healthy volunteers and patients; for limited or extensive vs no chronic graft-versus-host-disease (GVHD); and for decreased (Karnofsky o80) vs normal functional status (480). Patients were significantly more likely to have low LBMI at 6, 12 months, 2-3, 4-6 and 46 years than volunteers. In all, 38% of patients were below pre-HSCT LBMI at 4-6 years post-HSCT. Low LBMI was significantly associated with steroid treatment (OR 2.6, confidence intervals (CI) 1.3-5.2, P ¼ 0.008); limited (OR 5.5, CI 1.7-18.5, P ¼ 0.005) or extensive chronic GVHD (OR 20.3,, Po0.001); and decreased performance status (Karnofsky scores of p80) (OR 2.7, CI 1.3-5.9, P ¼ 0.01). Patients were more likely to have low LBMI than volunteers. Chronic GVHD and low performance status were associated with low LBMI; thus, complications and/or treatment increase the likelihood of low LBMI. Patients with hematological malignancies are usually well nourished at the time of allogeneic hematopoietic stem cell transplantation (HSCT). 1,2 However, nutritional consequences after HSCT have not been well studied. Underweight patients are at increased risk of death in the early post-HSCT period, and nonrelapse mortality is greater for extremely underweight or overweight patients. 3,4 High body mass index (BMI), weight normalized for height, may also affect treatment-related toxicity and mortality. 5 Furthermore, low lean body mass (LBM) has been associated with poor outcome and increased length of hospital stay. 6 Allogeneic HSCT and associated complications, including infections and graft-versus-host-disease (GVHD), can affect body weight and body composition. Immunosuppressive therapy after transplantation has been shown to alter skeletal muscle metabolism. 7 Corticosteroids promote muscle atrophy by increasing the rate of protein catabolism, amino-acid efflux, while simultaneously decreasing the rate of protein synthesis. 8 Thus, treatment and complications following HSCT exert profound negative effects on LBM.As low LBM is associated with poor outcome, the evaluation of LBM and body fat changes in pre-and post-HSCT patients can aid in adapting nutrition policy, for example, nutrition support in malnutrition and food restriction in obesity. 9 Just as BMI is useful in evaluating the excess or deficit in body weight in individuals of different heights, the lean body mass index (LBMI, kg/m 2 ) and body fat mass index (BFMI, kg/m 2 ) are potentially useful in evaluating body composition parameters by effectively eliminating differences in LBM and body fat with height. 10 Height-indepe...

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“…According to many authors, EN is a safer approach as a transition step from parenteral nutrition to the oral diet in patients with gastrointestinal complications. [14][15][16] TPN is potentially associated with significant limitations, including fluid overload, catheter-site infections, subclavian vein thromboses, delay in platelet engraftment, and suppression of normal appetite. 17 In the present study, TPN was initiated if the patient could receive < 50% of the daily recommended intake or could not receive oral diet for more than 5 days or if the patient had severe mucositis.…”

Section: Exp Clin Transplantmentioning

confidence: 99%

Untitled

N¹,

Gündüz²,

Tavil³

et al. 2017

Exp Clin Transplant

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Objectives: The aim of this study was to evaluate nutritional status in children who underwent hematopoietic stem cell transplant compared with a healthy control group. A secondary aim was to utilize midupper arm circumference as a measure of nutritional status in these groups of children. Materials and Methods: Our study group included 40 children (18 girls, 22 boys) with mean age of 9.2 ± 4.6 years (range, 2-17 y) who underwent hematopoietic stem cell transplant. Our control group consisted of 20 healthy children (9 girls, 11 boys). The children were evaluated at admission to the hospital and followed regularly 3, 6, 9, and 12 months after discharge from the hospital. Results: In the study group, 27 of 40 patients (67.5%) received nutritional support during hematopoietic stem cell transplant, with 15 patients (56%) receiving enteral nutrition, 6 (22%) receiving total parenteral nutrition, and 6 (22%) receiving enteral and total parenteral nutrition. Chronic malnutrition rate in the study group was 47.5% on admission to the hospital, with the control group having a rate of 20%. One year after transplant, the rate decreased to 20% in the study group and 5% in the control group. The mid-upper arm circumference was lower in children in the study group versus the control group at the beginning of the study (P < .05). However, there were no significant differences in mid-upper arm circumference measurements between groups at follow-up examinations (P > .05). During follow-up, all anthropometric measurements increased significantly in both groups. Conclusions:Monitoring nutritional status and initiating appropriate nutritional support improved the success of hematopoietic stem cell transplant and provided a more comfortable process during the transplant period. Furthermore, mid-upper arm circumference is a more sensitive, useful, and safer parameter that can be used to measure nutritional status of children who undergo hematopoietic stem cell transplant.

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Nutrition Support in Bone Marrow Transplant Recipients

Cited by 57 publications

References 79 publications

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

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