Annals of Hematology

, Volume 96, Issue 4, pp 617–625 | Cite as

Nutritional risk in allogeneic stem cell transplantation: rationale for a tailored nutritional pathway

  • Takashi Aoyama
  • Osamu Imataki
  • Keita Mori
  • Kanako Yoshitsugu
  • Masafumi Fukaya
  • Ikue Okamura
  • Terukazu Enami
  • Raine Tatara
  • Takashi Ikeda
Original Article


Hematopoietic stem cell transplantation carries nutrition-related risks. Therefore, nutritional therapy needs to be initiated before transplantation even takes place. We assessed nutritional risk among patients who underwent allogeneic stem cell transplantation. We assessed nutrient supply (calorie supply and protein supply) by chart review. Assessments were made from the pretreatment phase of transplantation to after the end of parenteral nutrition in 51 patients who underwent allogeneic stem cell transplantation at Shizuoka Cancer Center between 2007 and 2012. We compared nutrition-related adverse events and parameters between two groups: those in whom % loss of body weight was ≥7.5 and those in whom % loss of body weight was <7.5. A correlation was observed between changes in weight and skeletal muscle mass (r = 0.89; P < 0.0001). A weak correlation was observed between % loss of body weight and nutrient supply of calories (r = 0.517; P = 0.0001). There were significant differences between the % loss of body weight ≥7.5 group and the % loss of body weight <7.5 group in the following variables: % loss of body weight, nutrient supply from calories and protein; orally ingested nutrient supply from calories and protein; start day of oral intake; and acute graft-versus-host disease. Orally ingested calories were negatively correlated with nutrition-related adverse events in both groups. Early and customized nutritional intervention may be optimal for all patients who undergo allogeneic stem cell transplantation to ameliorate body weight loss associated with nutrition-related adverse events.


Allogeneic blood stem cell transplantation Nutritional pathway Bioelectrical impedance analysis Nutrition-related adverse events 



The authors would like to thank the following people for their help in collecting data for this study: Kazuhiro Kawasaki, Mizuki Fukuda, Shizuka Hirabayashi, Keiko Ishide, and Yuri Endo, Division of Nursing, Shizuoka Cancer Center, Shizuoka, Japan; Tetsuo Kume, Department of Pharmacy, Shizuoka Cancer Center, Shizuoka, Japan; Miho Suzuki, Division of Dentistry, Shizuoka Cancer Center, Shizuoka, Japan; and Hitomi Shiozaki, Naomi Katsumata, and Mariko Mori, Division of Nutrition, Shizuoka Cancer Center, Shizuoka.

Statement of authorship

The work presented here was performed in collaboration with all authors who contributed to the design of the experiment and writing of the manuscript. TA, OI, and KM performed the experiments, data analysis, and interpretation and drafted the manuscript. TI participated in the design and coordination of the study and helped draft the manuscript. All authors read and approved the final manuscript.

Sources of funding

This work was supported by a Grant-in-Aid from the Japanese Foundation for the Multidisciplinary Treatment of Cancer and the Foundation for Promotion of Cancer Research.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Aoyama T, Imataki O, Kawakami K et al (2007) Nutritional pathway for allogenic stem cell transplantation. J JSPEN 22:35–39 (in Japanese)Google Scholar
  2. 2.
    Aoyama T, Imataki O, Kawakami K et al (2007) Nutritional pathway for autologous stem cell transplantation. Jpn J Cancer Chemother 34:1249–1253Google Scholar
  3. 3.
    Aoyama T, Okamura I, Ikeda T et al (2013) Usefulness of nutritional therapy in autologous peripheral blood stem cell transplantation. J JSPEN 28:67–74Google Scholar
  4. 4.
    Weisdorf SA, Lysne J, Wind D et al (1987) Positive effect of prophylactic total parenteral nutrition on long-term outcome of bone marrow transplantation. Transplantation 43:833–838CrossRefPubMedGoogle Scholar
  5. 5.
    Szeluga DJ, Stuart RK, Brookmeyer R et al (1987) Nutritional support of bone marrow transplant recipients: a prospective, randomized clinical trial comparing total parenteral nutrition to an enteral feeding program. Cancer Res 47:3309–3316PubMedGoogle Scholar
  6. 6.
    Hwang TL, Chiang CL, Wang PN et al (2001) Parenteral nutrition support after bone marrow transplantation: comparison of total and partial parenteral nutrition during the early posttransplantation period. Nutrition 17:773–775CrossRefPubMedGoogle Scholar
  7. 7.
    Guièze R, Lemal R, Cabrespine A et al (2014) Enteral versus parenteral nutritional support in allogeneic haematopoietic stem-cell transplantation. Clin Nutr 33:533–538CrossRefPubMedGoogle Scholar
  8. 8.
    Seguy D, Duhamel A, Rejeb MB et al (2012) Better outcome of patients undergoing enteral tube feeding after myeloablative conditioning for allogeneic stem cell transplantation. Transplantation 94:287–294CrossRefPubMedGoogle Scholar
  9. 9.
    Andersen S, Brown T, Kennedy G et al (2015) Implementation of an evidenced based nutrition support pathway for haematopoietic progenitor cell transplant patients. Clin Nutr (England) 34(3):536–540CrossRefGoogle Scholar
  10. 10.
    Lipkin AC, Lenssen P, Dickson BJ (2005) Nutrition issues in hematopoietic stem cell transplantation: state of the art. Nutr Clin Pract 20:423–439CrossRefPubMedGoogle Scholar
  11. 11.
    Kopp M, Schweigkofler H, Holzner B et al (2000) EORTC QLQ-C30 and FACT-BMT for the measurement of quality of life in bone marrow transplant recipients: a comparison. Eur J Haematol 65:97–103CrossRefPubMedGoogle Scholar
  12. 12.
    Ravasco P, Monteiro-Grillo I, Vidal PM et al (2004) Cancer: disease and nutrition are key determinants of patients’ quality of life. Support Care Cancer 12:246–252CrossRefPubMedGoogle Scholar
  13. 13.
    Deeg HJ, Seidel K, Bruemmer B (1995) Impact of patient weight on non-relapse mortality after marrow transplantation. Bone Marrow Transplant 15:461–468PubMedGoogle Scholar
  14. 14.
    Dickson TM, Kusnierz-Glaz CR, Blume KG (1999) Impact of admission body weight and chemotherapy dose adjustment on the outcome of autologous bone marrow transplantation. Biol Blood Marrow Transplant 5:299–305CrossRefPubMedGoogle Scholar
  15. 15.
    Dickson TC (1997) Clinical pathway nutrition management for outpatient bone marrow transplantation. J Am Diet Assoc 97:61–63CrossRefPubMedGoogle Scholar
  16. 16.
    Rzepecki P, Barzal J, Oborska S (2010) Blood and marrow transplantation and nutritional support. Support Care Cancer 18:57–65CrossRefGoogle Scholar
  17. 17.
    Martin-Salces M, de Paz R, Canales MA et al (2008) Nutritional recommendations in hematopoietic stem cell transplantation. Nutrition 24:769–775CrossRefPubMedGoogle Scholar
  18. 18.
    White JV, Guenter P, Jensen G et al (2012) Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Parenter Enter Nutr 36(3):275–283Google Scholar
  19. 19.
    Shafer K, Siders WA, Johnson LKMS et al (2009) Validity of segmental multiple-frequency bioelectrical impedance analysis to estimate body composition of adults across a range of body mass index. Nutrition 25:25–32CrossRefPubMedGoogle Scholar
  20. 20.
    John JC (1991) Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation. Am J Clin Nutr 54:963–969Google Scholar
  21. 21.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefPubMedGoogle Scholar
  22. 22.
    Saijo N, Fukuda H, Shimoyma M et al (2004) Japanese translation of common terminology criteria for adverse events (CTCAE), and instructions and guidelines. Int J Clin Oncol 3:1–82 (in Japanese)Google Scholar
  23. 23.
    Seattle Cancer Care Alliance (2002) Hematopoietic stem cell transplantation nutrition care criteria, 2nd edn. Seattle Cancer Care Alliance, Seattle, WAGoogle Scholar
  24. 24.
    Ishikawa-Takata K, Tabata I, Sasaki S et al (2008) Physical activity level in healthy free-living Japanese estimated by doubly-labelled water method and International Physical Activity Questionnaire. Eur J Clin Nutr 62:885–891CrossRefPubMedGoogle Scholar
  25. 25.
    Tappy L (1996) Thermic effect of food and sympathetic nervous system activity in humans. Reprod Nutr Dev 36:391–397CrossRefPubMedGoogle Scholar
  26. 26.
    Cahill RA, Spitzer TR, Mazumder A (1996) Marrow engraftment and clinical manifestations of capillary leak syndrome. Bone Marrow Transplant 18:177–184PubMedGoogle Scholar
  27. 27.
    Skop A, Kolarzyk E, Skotnicki AB (2005) Importance of parenteral nutrition in patients undergoing hematopoietic stem cell transplantation procedures in the autologous system. J Parenter Enter Nutr 29:241–247CrossRefGoogle Scholar
  28. 28.
    Arfons LM, Lazarus HM (2005) Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo. Bone Marrow Transplant 36:281–288CrossRefPubMedGoogle Scholar
  29. 29.
    Japanese Society for Parenteral and Enteral Nutrition (2013) Parenteral and enteral nutrition guidelines. J JSPEN (3):363–364Google Scholar
  30. 30.
    Spitzer TR (2015) Engraftment syndrome: double-edged sword of hematopoietic cell transplants. Bone Marrow Transplant 50:469–475CrossRefPubMedGoogle Scholar
  31. 31.
    McDiarmid S (2002) Nutritional support of the patient receiving high-dose therapy with hematopoietic stem cell support. Can Oncol Nurs J 12:102–115CrossRefPubMedGoogle Scholar
  32. 32.
    Crowther M, Avenell A, Culligan DJ (2009) Systematic review and meta-analyses of studies of glutamine supplementation in haematopoietic stem cell transplantation. Bone Marrow Transplant 44:413–425CrossRefPubMedGoogle Scholar
  33. 33.
    Song EK, Yim JM, Yim JY et al (2013) Glutamine protects mice from acute graft-versus-host disease (aGVHD). Biochem Biophys Res Commun 435:94–99CrossRefPubMedGoogle Scholar
  34. 34.
    Wischmeyer PE (2008) Glutamine: role in critical illness and ongoing clinical trials. Curr Opin Gastroenterol 24:190–197CrossRefPubMedGoogle Scholar
  35. 35.
    Brown SA, Goringe A, Fegan C et al (1998) Parenteral glutamine protects hepatic function during bone marrow transplantation. Bone Marrow Transplant 22:281–284CrossRefPubMedGoogle Scholar
  36. 36.
    Coghlin Dickson TM, Wong RM, Offrin RS et al (2000) Effect of glutamine supplementation during bone marrow transplantation. J Parenter Enter Nutr 24:61–66CrossRefGoogle Scholar
  37. 37.
    Iestra JA, Fibbe WE, Zwinderman AH et al (2002) Body weight recovery, eating difficulties and compliance with dietary advice in the first year after stem cell transplantation: a prospective study. Bone Marrow Transplant 29:417–424CrossRefPubMedGoogle Scholar
  38. 38.
    Caro MM, Laviano A, Pichard C (2007) Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 26:289–301CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Takashi Aoyama
    • 1
  • Osamu Imataki
    • 2
  • Keita Mori
    • 3
  • Kanako Yoshitsugu
    • 4
  • Masafumi Fukaya
    • 4
  • Ikue Okamura
    • 4
  • Terukazu Enami
    • 4
  • Raine Tatara
    • 4
  • Takashi Ikeda
    • 4
  1. 1.Division of NutritionShizuoka Cancer CenterShizuokaJapan
  2. 2.Division of Hematology & Stem Cell TransplantationKagawa University HospitalIkenobe Miki TownJapan
  3. 3.Division of Biostatistical Chief, Clinical Research Promotion Unit, Clinical Research CenterShizuoka Cancer CenterShizuokaJapan
  4. 4.Division of Hematology & Stem Cell TransplantationShizuoka Cancer CenterShizuokaJapan

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