Overview of nutritional approach in hematopoietic stem cell transplantation: COVID-19 update

Abstract

The coronavirus disease 2019 (COVID-19) is caused by the newly discovered SARS-CoV-2. Hematopoietic stem cell transplantation (HSCT) is a high-risk procedure. The novelty of COVID-19 has created more uncertainty during all phases of HSCT. It is thought that HSCT patients taking immunosuppressive agents are more likely to contract COVID-19 than healthy individuals are. Appropriate care precautions should be taken with patients undergoing HSCT to minimize the risk of COVID-19, and appropriate treatment methods must be followed in patients infected with COVID-19. Malnutrition has become a significant problem in HSCT patients during the COVID-19 pandemic. The causes of malnutrition in HSCT patients are multifactorial. However, the most important reason is the decrease in energy and nutrient intake. The HSCT procedure can lead to many complications such as dysgeusia, mucositis, diarrhea, constipation, xerostomia and vomiting/nausea. Improving the nutritional status of HSCT patients by managing each of these special complications with an appropriate nutritional approach is essential for successful engraftment. This review aims to provide a comprehensive overview of the specific complications affecting the nutritional status of HSCT patients and their nutritional approach during the challenging COVID-19 pandemic.

Metabolically Primed Multipotent Hematopoietic Progenitors Fuel Innate Immunity

“…Our data can also help to inform the development of nutrient/metabolite biomarker panels for stem cell function. Such tools can inform dietary interventions to promote HSPC function, particularly in prospective recipients of bone marrow transplants, a high-risk procedure that can lead to malnutrition and significant nutrient deficiencies 61,62 . Lastly, our results suggest that therapeutic interventions to alter the metabolism of HSPCs may not target all cells uniformly, given their underlying metabolic heterogeneity.…”

Self-care guidelines for patients in the post-hematopoietic stem cell transplantation period: a scoping review

“…Regarding the implementation of new lifestyle habits, self-care ( 20 , 22 ) , nutritional guidelines ( 20 - 21 , 25 , 28 - 29 ) , food hygiene ( 20 - 21 , 25 , 28 ) , fluid intake ( 20 ) , hand ( 25 , 28 ) and personal hygiene ( 21 ) , correct medication use ( 20 - 21 , 23 , 26 ) , and complications ( 22 , 27 - 28 ) were the most cited in the studied sample.…”

“…Therefore, it is important to handle, prepare, and consume food properly to avoid infections transmitted by microorganisms. To do so, the following precautions must be taken: cleaning - wash hands, surfaces, and products with soap and water; separation - to avoid cross-contamination, store food and water properly; cooking - cook food and water at the appropriate temperature; and refrigeration - refrigerate immediately ( 20 ) .…”

“…Following nursing guidance, especially related to medications, is one of the biggest challenges, and this fact correlates with non-adherence to pharmacotherapy, the deficit of social support, and the need for instrumental support from family members/caregivers, who are often responsible for reminding transplant patients of medications and their schedules ( 20 ) . Furthermore, the effectiveness of communication between the health team and the patient, as well as the quality of this relationship, are also seen as factors linked to patient adherence to treatment, especially to medications ( 25 ) .…”

“…The guidelines of the 2017 European Conference on Infections in Leukemia (ECIL 7) indicate that immunobiologics should be administered from six months after D0 ( 36 ) . Even after administration of the vaccines, the patient’s transplanted immune system is still considered fragile, which justifies reinforcing nursing instructions regarding timing and return for subsequent doses and care when returning to work ( 21 ) and contact with large groups that tend to have infected people ( 11 , 20 ) . Therefore, it is necessary for the healthcare professional to ensure that the patient understands the importance of protective isolation ( 28 - 29 ) and mask use, so that the patient has awareness and tendency to avoid risky behaviors ( 28 ) .…”