Weight loss and malnutrition in patients with chronic graft-versus-host disease

Jacobsohn, David A.; Margolis, Jeffrey; Doherty, Jon; Anders, Viki; Vogelsang, Georgia B.

doi:10.1038/sj.bmt.1703352

Cited by 68 publications

(50 citation statements)

References 29 publications

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“…Oral manifestations of cGVHD can significantly affect the life quality of patients through discomfort and impairment of the oral intake leading to malnutrition and increased morbidity [10]. It is often refractory to conventional treatment and therefore complementary topical treatment is required.…”

Section: Introductionmentioning

confidence: 99%

The effect of budesonide mouthwash on oral chronic graft versus host disease

et al. 2006

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Oral chronic graft versus host disease (cGVHD) is common and a major cause of morbidity and loss of quality of life in long term survivors. Cyclosporine with prednisone remains the first line therapy for oral manifestations of cGVHD. However, even with routine administration of systemic agents, many patients with oral manifestations of cGVHD do not have resolution of their disease and may benefit from incorporation of local therapy. Budesonide is a highly potent steroid which has minimal systemic side effects and being used for oral cGVHD. We designed a retrospective study to compare treatment results of patients with oral cGVHD who received topical budesonide in addition to systemic therapy that consists of combined prednisone and cyclosporine (Group A, n = 12), with the treatment results of patients who were administered the same systemic therapy alone (Group B, n = 11) to determine whether budesonide mouthwash had any advantage on response rates. Three mg topical budesonide/10 ml saline was used 3-4 times a day for up to 6 months in group A. Diagnosis, clinical staging, and treatment response scoring for cGVHD were performed according to National Institutes of Health (NIH) consensus criteria. At the baseline examination, there were no statistically significant differences in terms of median oral cGVHD examination scores between two groups. After treatment, there was statistically significant decrease in median oral cGVHD examination scores compared to baseline (P < 0.001 and 0.021), and significant differences were found between two groups (P < 0.032). Overall response rate was 83% and 36% for group A and B, respectively (P = 0.036). However, no statistically significant differences were found between median pain scores of two groups before and after treatment (P = 0.740 and P = 0.091). No major systemic side effects and oral candidiasis were observed in two groups of patients. We concluded that topical budesonide might be added to systemic therapy to obtain better response rates in patients with oral cGHVD. Am. J. Hematol. 82:349-356, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Introductionmentioning

confidence: 99%

The effect of budesonide mouthwash on oral chronic graft versus host disease

et al. 2006

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“…[2][3][4] Lenssen et al have reported that long-term survivors experienced weight loss, especially after 100 days post-transplant. 2 One major cause of weight loss was insufficient caloric intake.…”

Section: Introductionmentioning

confidence: 99%

Severe weight loss in 3 months after allogeneic hematopoietic SCT was associated with an increased risk of subsequent non-relapse mortality

Fuji¹,

Mori

Khattry

et al. 2014

Bone Marrow Transplant

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Patients after allogeneic hematopoietic SCT (HSCT) are at risk of malnutrition. To assess the impact of malnutrition after allogeneic HSCT on transplant outcomes, we conducted a retrospective study. Adult patients who received allogeneic HSCT from 2000 to 2009 for standard-risk leukemia and achieved disease-free survival up to 3 months after allogeneic HSCT were included. From participating centers, 145 patients were enrolled. Median age was 46 years (19-68). Patients were classified based on weight loss during 3 months after allogeneic HSCT as follows: normal group (weight loss o 5%, n = 53), mild malnutrition group (5% ⩽ weight loss o 10%, n = 47), severe malnutrition group (10% ⩽ weight loss, n = 45). The cumulative incidences of 2-year nonrelapse mortality (NRM) were 3.8% in the normal group, 8.5% in the mild malnutrition group and 27.3% in the severe malnutrition group. The probabilities of a 2-year OS were 73.2% in the normal group, 74.5% in the mild malnutrition group and 55.3% in the severe malnutrition group. In multivariate analysis, severe malnutrition was associated with an increased risk of NRM and a worse OS. In conclusion, weight loss ⩾ 10% was associated with a worse clinical outcome. Prospective studies that identify patients at risk of malnutrition and intervention by a nutritional support team are warranted.

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“…In this study, symptoms thought to contribute to weight loss, such as odynophagia and oral sensitivity, were not related to weight loss. 13 In a large retrospective review of 192 children and adults 1 year post allo-SCT, nutrition-related problems (weight changes, oral sensitivity, xerostomia and so on.) were more frequent in patients with GVHD than in patients without GVHD.…”

Section: Results Of the Literature Studymentioning

confidence: 99%