Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease

Mattsson, Jonas; Westin, Stefan; Edlund, S; Remberger, Mats

doi:10.1038/sj.bmt.1705493

Cited by 87 publications

(67 citation statements)

References 22 publications

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“…13,33 The low frequency of aGVHD, and particularly its gut manifestations, suggests that EN started early may decrease both its incidence and severity. In a study of 231 allo-SCT patients receiving PN, Mattsson et al 34 found that poor oral nutrition after allogeneic SCT correlated with severe aGVHD. In the latter study, a period of over 9 days with no oral intake was associated with a high risk of grade III --IV aGVHD.…”

Section: Discussionmentioning

confidence: 99%

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Azarnoush

Bruno

Béghin

et al. 2012

Bone Marrow Transplant

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Parenteral nutrition (PN) is the treatment of choice for nutritional support of patients undergoing allo-SCT following myeloablative conditioning (MAC). Here we prospectively assessed the outcomes of early enteral nutrition (EN) in a paediatric cohort. From 2003 to 2010, all 65 consecutive children undergoing MAC allo-SCT at our referral centre began EN the day after transplantation. Post-transplant and nutritional outcomes of patients receiving only EN (EN group, n ¼ 50) were compared with those of patients requiring additional PN (EN-PN group, n ¼ 15). In the EN group time to platelet recovery (P ¼ 0.01) and length of hospitalisation (Po0.001) were shorter, while in the EN-PN group the proportion of unrelated donors (P ¼ 0.02) and the frequency of severe acute GVHD (aGVHD; P ¼ 0.004) were higher. All patients were alive at day 100. PN was started 14 days after transplant because of poor digestive tolerance to EN or severe gut aGVHD. The body mass index Z-score in the EN-PN group decreased from transplant to discharge (P ¼ 0.02). In only 23% of cases was PN required for severely ill patients. Our results suggest that EN might be considered to be an option for nutritional support in children undergoing MAC allo-SCT, while PN should be used only as a rescue option, possibly in combination with EN.

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Section: Discussionmentioning

confidence: 99%

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Azarnoush

Bruno

Béghin

et al. 2012

Bone Marrow Transplant

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“…Although well described, GI complications have been reported as the most debilitating side effect of HSCT [65], in some cases delaying hospital discharge [66,67] and contributing to hospital readmission following HSCT [68]. In addition, the relationship between poor nutritional status and clinical outcomes such as fever [69] and GVHD severity [70] are being explored. Various management strategies exist [71]; however, the findings of this study support a conclusion that more research is needed to reduce the burden of gastrointestinal symptoms in allogeneic HSCT patients and understand the impact on clinical outcomes such as functional status, nutritional status, and length of stay.…”

Section: Discussionmentioning

confidence: 99%

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

Bevans

Mitchell

Marden

2008

Support Care Cancer

180

133

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Goals of Work-Despite advances in allogeneic hematopoietic stem cell transplantation (HSCT), post-transplant complications are common and patients' symptom experience has not been well documented.Purpose-To characterize the symptom experience of adult patients pre-transplantation and days 0, 30 and 100 after allogeneic HSCT.Methods-Data from 76 participants enrolled in a prospective Health-Related Quality of Life (HRQL) study were used. Symptom occurrence, distress, and clusters were determined based on the 11 symptoms of the Symptom Distress Scale (SDS).Results-Participants were on average 40 years old (SD ± 13.5). The majority (54%) received reduced intensity conditioning. Prevalent symptoms included fatigue (68%) and worry (68%) at baseline; appetite change (88%) at day 0; and fatigue at days 30 (90%) and 100 (81%). Participants reported the following symptoms as severely distressing: worry (16%) [baseline], insomnia (32%) [Day 0], appetite change (22%) [Day 30] and fatigue (11%) [Day 100]. The total SDS score was highest at day 0 (M = 26.6 ± 7.6) when the highest number of symptoms were reported [Mdn = 8 (1 -11)]. Symptoms formed clusters comprised of fatigue, appearance change, and worry at baseline, and fatigue, insomnia and bowel changes at days 0 and 30. Compared to those with low symptom distress, participants with moderate/severe symptom distress reported poorer HRQL. Conclusion-AllogeneicHSCT patients present for transplantation with low symptom distress yet experience multiple symptoms and high symptom distress after HSCT conditioning. Understanding the symptom experience of allogeneic HSCT patients can guide management strategies and improve HRQL.

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“…Injury to the gut during conditioning therapy before SCT plays a pivotal role in the initiation of increasing the translocation of inflammatory stimuli such as endotoxin, which promotes further inflammation and additional GI tract damage. The GI tract is critical to the initiation of the 'cytokine storm' characteristic of acute GVHD 15 . With the development of acute GVHD, patients are often recommended to withhold oral intake (NPO: Nil Per Os, 'bowel rest') to avoid further damage to the GI mucosa.…”

Section: Discussionmentioning

confidence: 99%

Stepwise diet management in pediatric gastrointestinal graft versus host disease

Koç¹,

Gündüz²,

Azık³

et al. 2016

Turk J Pediatr

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Gastrointestinal tract is one of the major systems affected by graft-versus-host disease (GVHD). Injury to the gut during conditioning therapy before stem-cell transplantation (SCT) plays a pivotal role in the initiation of inflammatory stimuli. We reviewed medical records of the patients who underwent SCT between April 2010 and June 2013 in our center. A stepwise upgrade diet was given to the children with acute GI-GVHD (Gastrointestinal GVHD) including parenteral and enteral nutrition. A total of 105 patients underwent SCT and seven patients developed grade III-IV acute GI-GVHD. Total parenteral nutrition (TPN) was initiated to all patients after the diagnosis of GI-GVHD and minimal enteral nutrition (1-2 ml/kg/day standard pediatric enteral formula/special meat soup) was given to the patients. GI-GVHD improved in all patients with no change in body weight, and recovery to a normal diet took 10-30 days. Stepwise diet management of oral nutrition contributed to rapid improvement of grades III-IV acute GI-GVHD.

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Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease

Cited by 87 publications

References 22 publications

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

Stepwise diet management in pediatric gastrointestinal graft versus host disease

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