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