|
1
|
van Lieshout R, Tick LW, Beckers EAM, Biesbroek W, Custers S, Dieleman JP, Dijkstra M, Groenesteijn W, Heldens A, Hengeveld MM, Koene HR, Kranenburg S, van der Lee D, van der Put L, Rademakers N, Regelink JC, Regis M, Somer M, van Tilborg CJ, Westerweel PE, de Witte M, de Zeeuw S, Schouten HC, Beijer S. Associations of various medical nutrition therapy strategies with body composition, and physical and clinical outcomes in acute myeloid leukemia patients undergoing intensive remission-induction treatment: A multicenter prospective correlational study. Clin Nutr ESPEN 2025; 67:276-295. [PMID: 40054616 DOI: 10.1016/j.clnesp.2025.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 02/19/2025] [Accepted: 02/27/2025] [Indexed: 03/30/2025]
Abstract
BACKGROUND & AIMS Medical nutrition therapy (MNT) is commonly used in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing intensive remission-induction treatment to prevent malnutrition, particularly the loss of fat-free mass (FFM)/muscle mass, as well as associated adverse outcomes. However, studies examining the associations of proactive versus wait-and-see approaches toward MNT with nutritional, physical, and clinical outcomes in these patients are lacking. Therefore, this study aimed to explore the associations of these different MNT approaches with body composition changes, as well as physical and clinical outcomes in AML/MDS patients undergoing intensive remission-induction treatment. Additionally, the study aimed to explore the relationships between body composition changes and physical and clinical outcomes, and whether these associations varied between the proactive and wait-and-see strategies. METHODS In this multicenter prospective correlational study, newly diagnosed AML/MDS patients undergoing intensive remission-induction treatment were included. Patients were treated in one of five hospitals using a proactive approach toward MNT, initiating MNT when nutritional intake became inadequate, or in the single hospital in the Netherlands that followed a wait-and-see strategy, limiting the use of MNT to exceptional and severe cases only. Body composition was assessed at the start of treatment, weekly during admission and at discharge, and handgrip strength, and patient-reported physical functioning and fatigue at treatment initiation and discharge. Information on number of complications, and duration of fever and hospital length of stay (LOS) was collected from medical records. Within-group changes in body composition and between-group differences were tested using paired or independent t, Wilcoxon signed-rank or two-sample tests, respectively, or chi-square/Fisher's exact tests for proportions. The longitudinal patterns between proactive MNT approach/wait-and-see strategy hospitals were compared by means of linear mixed effects models. Associations between body composition changes and physical and clinical outcomes were explored using multiple linear regression models, and compared between proactive MNT approach/wait-and-see strategy hospitals. RESULTS In this study, 204 AML/MDS patients (54 % male, mean age: 56.3 ± 13.0 years) were included, of whom 140 underwent treatment in a hospital using a proactive approach toward MNT and 64 in the hospital following a wait-and-see strategy. In the proactive MNT approach hospitals, 57 % of patients received MNT during the first chemotherapy cycle versus 8 % of patients in the wait-and-see hospital (p < 0.0001). Both approaches toward MNT were associated with significant decreases in body weight, FFM/muscle mass, and muscle strength. However, losses in FFM/muscle mass and muscle strength did not differ significantly between the strategies, while body weight loss was lower with the proactive approach (estimated between-group difference during the first cycle: 0.44 kg/week (95 % CI 0.18-0.70 kg/week, p = 0.0008), primarily due to better preservation of fat mass (FM) (p < 0.05). Additionally, the proactive MNT strategy was associated with fewer nutrition impact symptoms (p < 0.0001), fewer complications (p = 0.01), and shorter LOS (33 days (IQR: 27-41) vs 29 days (IQR: 26-34), p = 0.009). Similar results were observed during the second chemotherapy cycle. Furthermore, better maintenance of body weight and indicators of FFM/muscle mass and FM were significantly associated with shorter LOS and fever duration, fewer complications, improved physical functioning and/or reduced fatigue. Several associations differed significantly between the two MNT strategies, given that decreased body composition parameters were associated with worse physical and clinical outcomes in the wait-and-see hospital, while in the proactive MNT approach hospitals these associations were opposite or attenuated and non-significant. CONCLUSION In AML/MDS patients undergoing intensive remission-induction treatment, a proactive approach toward MNT should be used, as it was associated with fewer nutrition impact symptoms, fewer complications, shorter LOS, and better body weight maintenance, mainly through better preservation of FM, compared to a wait-and-see strategy. Maintenance of body weight, FFM/muscle mass and/or FM was associated with improved physical and clinical outcomes. Given that proactive use of MNT could not prevent loss of FFM/muscle mass and muscle strength, future research should focus on combined nutritional and physical exercise interventions aimed at reducing these losses.
Collapse
Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Division Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Willemijn Biesbroek
- Department of Dietetics and Nutrition, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Stephanie Custers
- Department of Dietetics and Nutrition, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Jeanne P Dieleman
- Department of Research, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Myrthe Dijkstra
- Department of Physiotherapy, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Wanda Groenesteijn
- Department of Physiotherapy, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Aniek Heldens
- Department of Physiotherapy, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Martine M Hengeveld
- Department of Physiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Harry R Koene
- Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Suzanne Kranenburg
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Debbie van der Lee
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Liesbeth van der Put
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Nicky Rademakers
- Department of Physiotherapy, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Josien C Regelink
- Department of Internal Medicine, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Marta Regis
- Department of Research, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands; Department of Mathematics and Computer Science, Eindhoven University of Technology, 5600 MB Eindhoven, the Netherlands
| | - Maaike Somer
- Department of Dietetics and Nutrition, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Claudia J van Tilborg
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands
| | - Moniek de Witte
- Department of Internal Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sandra de Zeeuw
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Division Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Sandra Beijer
- Department of Dietetics and Nutrition, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; Department of Physiotherapy, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
| |
Collapse
|
|
2
|
Fuchs-Tarlovsky V, Alvarez-Altamirano K, Vedrenne-Gutiérrez F. Evaluation and Prognostic Impact of Nutrition in Patients with Acute Leukemia: A Narrative Review. Curr Oncol Rep 2025; 27:625-633. [PMID: 40195210 DOI: 10.1007/s11912-025-01671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2025] [Indexed: 04/09/2025]
Abstract
PURPOSE OF THIS REVIEW Acute leukemia (AL) is a hematological neoplasm with rapid progression that affects nutritional status of patients. Assessing nutrition in patients with haematological malignancies poses challenges due to the rapid progression of the disease, the variety of methods for evaluating malnutrition. In this review we will provide evidence of the need of early malnutrition diagnosis thru timely assessment and the implications of malnutrition in patients evolution in patients with AL. RECENT FINDINGS The prevalence of malnutrition ranging from 15 to 26.5% among patients with AL. It is well known that inflammation and cytokine production have been recognized as potential mechanisms of CCS in hematologic malignancies. Regardless of the mechanism underlying Cancer Cachexia Syndrome (CCS) in AML, patients undergoing conditioning chemotherapy and during transplant or antineoplastic treatment. In addition to this, patients with AL undergoing chemotherapy frequently face two main challenges: oral mucositis (OM) and neutropenic colitis (NC). Both conditions challenge nutrition intake and nutrients absorption which make them more susceptible to have nutritional deficits. Malnutrition in patients with acute leukemia face a higher risk of therapy failure, increased rates of relapse, and higher mortality rates. Nutritional status impact patient's prognosis in many ways, malnutrition increases risk of antineoplastic treatment toxicities, hospital stay, and cost, as well reduces quality of life and this condition worsens patient's prognosis.
Collapse
Affiliation(s)
- Vanessa Fuchs-Tarlovsky
- Servicio de Nutrición Clínica, Hospital General de México, Dr Balmis 148, Colonia Doctores, Delegación Cuauhthemoc, Mexico City, 06720, Mexico.
| | - Karolina Alvarez-Altamirano
- Servicio de Nutrición Clínica, Hospital General de México, Dr Balmis 148, Colonia Doctores, Delegación Cuauhthemoc, Mexico City, 06720, Mexico
| | - Fernand Vedrenne-Gutiérrez
- School of Medicine and Health Sciences, Universidad Anáhuac México, Huixquilucan, Estado de México, México
| |
Collapse
|
|
3
|
Li J, Wang Y, Dong C, Luo L. Advancements in leukemia management: Bridging diagnosis, prognosis and nanotechnology (Review). Int J Oncol 2024; 65:112. [PMID: 39364739 PMCID: PMC11542963 DOI: 10.3892/ijo.2024.5700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 09/19/2024] [Indexed: 10/05/2024] Open
Abstract
Leukemia is a cancer that starts in blood stem cells in the bone marrow. Today, the proper diagnosis and prognosis of leukemia are essential in mitigating the morbidity and mortality associated with this malignancy. The advent of novel biomarkers, particularly those related to minimal residual disease, has paved the way for personalized therapeutic strategies and enables the quantitative assessment of patient responses to treatment regimens. Novel diagnostic and targeted drug delivery may be helpful for the improved management of leukemia. Genetic clinical parameters, such as chromosomal abnormalities, are crucial in diagnosing and guiding treatment decisions. These genetic markers also provide valuable prognostic information, helping to predict patient outcomes and tailor personalized treatment plans. In the present review, the studies on the diagnostic and prognostic parameters of leukemia were analyzed. The prognosis of leukemia was investigated in most of the studies, and the remaining were performed on diagnosis. The clinical and laboratory prognostic parameters were the most common, followed by diagnostic hematological parameters, diagnostic blood parameter studies, and diagnostic immunological parameters. Clinical and laboratory prognostic and hematologic parameters were the most extensively studied. The methods used to diagnose and prognose the leukemia cases in these studies were predominantly clinical hematology. Numerous surface proteins and receptors, including CD45, CD27, CD29, CD38, CD27, CD123, CD56 and CD25, react similarly in various kinds of leukemia, which are ideal for targeted drug delivery. Drug delivery to leukemia cells encounters several significant obstacles, including heterogeneity, that hinder the effectiveness of treatment. Nanocarriers play a critical role in targeted drug delivery for leukemia by enhancing the precision of treatments directed at surface proteins and receptors. Additionally, they can be functionalized with targeting drugs and antibodies to target specific tissues and cells.
Collapse
Affiliation(s)
- Jingbo Li
- Department of Ultrasound Medicine, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Yingxue Wang
- Department of Ultrasound Medicine, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Chunli Dong
- Department of Critical Care Medicine, Jilin People's Hospital, Changchun, Jilin 130021, P.R. China
| | - Lifu Luo
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| |
Collapse
|
|
4
|
van Lieshout R, Tick LW, Beckers EAM, Biesbroek W, Dieleman JP, Dijkstra M, Groenesteijn W, Koene HR, Kranenburg S, van der Lee D, van der Put-van den Berg L, Rademakers N, Regelink JC, van Tilborg CJ, Westerweel PE, de Zeeuw S, Schouten HC, Beijer S. Changes in nutritional status and associations with physical and clinical outcomes in acute myeloid leukemia patients during intensive chemotherapy. Eur J Clin Nutr 2024; 78:1082-1094. [PMID: 39127840 DOI: 10.1038/s41430-024-01488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND/OBJECTIVES Patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) often receive medical nutrition therapy (MNT) during intensive remission-induction treatment. Since little is known about changes in nutritional status, specifically body composition, in this patient population, these changes and their associations with physical and clinical outcomes were assessed. SUBJECTS/METHODS In this multicenter prospective observational study, newly diagnosed AML/MDS patients who received intensive remission-induction chemotherapy, routine dietary counseling by a dietician and MNT immediately upon inadequate nutritional intake, were included. At treatment initiation and discharge, nutritional status, including Patient-Generated Subjective Global Assessment (PG-SGA)-scores and body composition, physical outcomes and fatigue were assessed. Associations of nutritional status/body composition with physical outcomes, fatigue, fever duration, number of complications, time to neutrophil engraftment and hospital length of stay (LOS) (collected from medical records) were examined using multiple regression analysis. RESULTS In >91% of the 126 AML/MDS patients included, nutritional intake was adequate, with 61% receiving MNT. Nevertheless, body weight decreased significantly (p < 0.001) and mainly consisted of a loss of muscle/fat-free mass (FFM) (p < 0.001), while fat mass (FM) remained unchanged (p-value range = 0.71-0.77). Body weight and waist circumference showed significant negative associations with fever duration and/or number of complications. Significant positive associations were found between mid-upper arm muscle circumference (MUAMC) and physical functioning and between PG-SGA-scores and fatigue. Body weight and MUAMC were also negatively associated with LOS. CONCLUSION Despite MNT in AML/MDS patients undergoing intensive chemotherapy, muscle/FFM decreased while FM remained unchanged. Maintenance of nutritional status was associated with improved physical and clinical outcomes.
Collapse
Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Division Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Willemijn Biesbroek
- Department of Dietetics and Nutrition, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - Jeanne P Dieleman
- Department of Research, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Myrthe Dijkstra
- Department of Physiotherapy, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Wanda Groenesteijn
- Department of Physiotherapy, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - Harry R Koene
- Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Suzanne Kranenburg
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Debbie van der Lee
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | | | - Nicky Rademakers
- Department of Physiotherapy, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Josien C Regelink
- Department of Internal Medicine, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - Claudia J van Tilborg
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - Sandra de Zeeuw
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Division Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
- Department of Dietetics and Nutrition, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| |
Collapse
|
|
5
|
Pederzoli PRMP, Prata KDL, Cruz NG, Marzano PVDA, Martins MC, Costa LDA, de Andrade RK, Libânio MRIS, Custer B, Belisário AR. Evaluation of blood cell count using an automatic hematology analyzer to optimize collection of peripheral blood progenitor cells by leukapheresis. Hematol Transfus Cell Ther 2024; 46 Suppl 6:S150-S156. [PMID: 38719718 PMCID: PMC11726100 DOI: 10.1016/j.htct.2024.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/01/2024] [Accepted: 04/01/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND Autologous stem cell transplantation is a treatment modality for several diseases. Prediction of successful mobilization may be useful to optimize hematopoietic stem cell collection. STUDY DESIGN AND METHODS This was a retrospective study with data from transplantation candidates between September 2015 and December 2021 being analyzed. The medical record of each patient was reviewed to mine mobilization information. The laboratory data analyzed were CD34+ cell enumeration and pre-collection peripheral blood cell count. The primary outcome, good mobilization, was defined as a CD34+ cell count ≥20/μL. RESULTS This study included 807 patients. Increased patient weight, low mean corpuscular volume, high nucleated red blood cells, peripheral blood mononuclear cell and immature granulocyte counts were significantly associated with good mobilization. In addition, patients diagnosed with multiple myeloma were two times more likely to be good mobilizers than patients with lymphoma. The model was applied to a validation set to identify patients who underwent apheresis (CD34+ cell count ≥10 µL), resulting in a sensitivity of 69 %, a specificity of 95 %, positive predictive value of 98 %, and a negative predictive value of 50 %. CONCLUSION Success in mobilization was greater in patients who underwent the first mobilization cycle and who had a diagnosis of multiple myeloma. Furthermore, higher body weight, and nucleated red blood cells, immature granulocytes and mononuclear cell counts, as well as low mean corpuscular volumes, were associated with successful mobilization.
Collapse
Affiliation(s)
| | - Karen de Lima Prata
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, Minas Gerais 33400-000, Brazil
| | - Nathália Gomide Cruz
- Fundação Hemominas, Alameda Ezequiel Dias, 321, Belo Horizonte, Minas Gerais 30130-110, Brazil
| | - Pedro Victorio de Almeida Marzano
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, Minas Gerais 33400-000, Brazil
| | - Maurício Colombini Martins
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, Minas Gerais 33400-000, Brazil
| | - Luciana de Almeida Costa
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, Minas Gerais 33400-000, Brazil
| | - Roberta Kelly de Andrade
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, Minas Gerais 33400-000, Brazil
| | - Marcia Regina Issa Salomão Libânio
- Secretaria de Estado da Saúde de Minas Gerais, Cidade Administrativa, Edifício Minas, 12º andar, Rod. Papa João Paulo II - Serra Verde, Belo Horizonte, Minas Gerais 31585-200, Brazil
| | - Brian Custer
- Vitalant Research Institute, 360 Spear St Suite 200, San Francisco, CA 94105, USA; Department of Laboratory Medicine, UCSF. 185 Berry Street, Suite 100, Box 0134, San Francisco, CA 94143-0134, USA
| | - André Rolim Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, Minas Gerais 33400-000, Brazil.
| |
Collapse
|
|
6
|
López-Espinoza T, Sacomori C, Araya-Castro P, Quintiliano-Scarpelli D, Roldán P, Peña-Espinoza M, de Rezende LF, López-Vidal H. Photobiomodulation therapy to prevent oral mucositis and functional impairment in adult patients with haematological cancer undergoing haematopoietic stem cell transplantation: randomised trial protocol. BMJ Open 2024; 14:e088073. [PMID: 39461860 PMCID: PMC11529764 DOI: 10.1136/bmjopen-2024-088073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 09/16/2024] [Indexed: 10/29/2024] Open
Abstract
INTRODUCTION Oral mucositis is a highly prevalent condition in individuals treated for haematological neoplasms, primarily during haematopoietic stem cell transplantation (HSCT). The condition is known to delay recovery processes, increasing the risk of infection, the number of interventions and the length of hospital stays. The proposed Photobiomodulation Therapy for Oral Mucositis and Functional Impairment Transplantation Trial aims to assess the effectiveness and acceptability of using photobiomodulation in the oral cavity to prevent oral mucositis and functional impairment in adult patients undergoing HSCT. METHODS AND ANALYSIS This is an assessor-blinded and statistician-blinded, parallel-group randomised controlled clinical trial (photobiomodulation vs control group). PARTICIPANTS AND SETTING 30 patients, aged 18-65 years, with haematological neoplasms undergoing HSCT at the Clínica Dávila Oncology and Bone Marrow Transplant Unit. PRIMARY OUTCOME MEASURES oral mucositis will be assessed daily using the WHO grading scale, beginning on the day of transplant through day 20 post-transplant. Researchers will assess functional capacity using a 2 min step test, handgrip strength with the Jamar digital dynamometer, lower limb strength using a 30' sit-to-stand test and quality of life with the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation Questionnaire. Acceptability will be assessed by logging treatment adherence and using a Visual Analogue Scale. Assessments will occur at two time points (1): on admission to the transplant unit, before starting the conditioning regimen and (2) on the day of discharge. INTERVENTION three times per week photobiomodulation therapy using a diode laser device will begin the first day of conditioning and continue through day 3 post-transplant. ETHICS AND DISSEMINATION The Clínica Dávila and Universidad del Desarrollo Clinical Research Ethics Committees approved this study in accordance with the Helsinki Declaration. Patients' informed consent will be required. The dissemination strategy includes publication in scientific journals as well as presentations in the media and at conferences. TRIAL REGISTRATION NUMBER NCT06260111.
Collapse
Affiliation(s)
- Tomas López-Espinoza
- Universidad del Desarrollo Facultad de Medicina Clínica Alemana, Santiago, Chile
- Clínica Dávila, Santiago, Chile
| | - Cinara Sacomori
- Universidad del Desarrollo Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Paulina Araya-Castro
- Universidad del Desarrollo Facultad de Medicina Clínica Alemana, Santiago, Chile
| | | | | | | | - Laura Ferreira de Rezende
- Physical Therapy, Centro Universitário das Faculdades Associadas de Ensino, Sao Joao da Boa Vista, Brazil
| | | |
Collapse
|
|
7
|
Genç Z, Can G, Koç Uyan E, Üre ÜB. The effect of breathing exercises on chemotherapy-induced nausea and vomiting in autologous hematopoietic stem cell transplantation patients: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102618. [PMID: 38820708 DOI: 10.1016/j.ejon.2024.102618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE This research was conducted as a randomized controlled study to examine the effect of breathing exercises on managing chemotherapy-related nausea and vomiting in patients who underwent autologous hematopoietic stem cell transplantation. METHODS A randomized controlled trial design was used, including an intervention group doing breathing exercises and a control group receiving standard care for chemotherapy-induced nausea and vomiting. The sample was selected from patients hospitalized in the bone marrow transplantation unit. A total of 70 autologous hematopoietic stem cell transplantation patients (35 intervention and 35 control participants). Several variables were evaluated, including the frequence and degree of nausea and vomiting, the patient's nutritional status, and the need for antiemetics. Data were analyzed and interpreted using Mann Whitney U, Pearson chi-square test, Independent t-test, Mann Whitney U, and multiple linear regression. RESULTS It was found that there was a negative relationship between the number of breathing exercises, the number of nausea and vomiting and the severity of nausea. As the number of breathing exercises increased, the number nausea and vomiting, and severity of nausea decreased significantly (p < 0.05). It was found that the use of antiemetics decreased in the intervention group. Furthermore, it was found that the intervention group had higher daily food consumption on the 3rd, 7th, and 9th days (p < 0.05). CONCLUSION Breathing exercises were a practical approach to managing chemotherapy-related nausea and vomiting.
Collapse
Affiliation(s)
- Zeliha Genç
- Koc University Hospital, Department of Infection Control Nursing, Davutpaşa Street. No: 4, Koç Üniversitesi Hastanesi, Topkapı, Istanbul, Turkey.
| | - Gülbeyaz Can
- Istanbul University - Cerrahpaşa Florence Nightingale Faculty of Nursing, Abide-i Hurriyet Street, Izzetpasa, 34381, Sisli/Istanbul, Turkey.
| | - Ebru Koç Uyan
- Koç University Hospital, Department of Hematology/ Oncology, İstanbul, Turkey.
| | - Ümit Barbaros Üre
- Koç University Hospital, Department of Hematology/ Oncology, İstanbul, Turkey.
| |
Collapse
|
|
8
|
Gandossi C, Jessop H, Hahn A, Heininger L, Henes J, Radaelli AM, Carmagnola A, Morello E, Renica C, Bertulli A, Lazzari L, Kenyon M, Alexander T, Domenech A, Greco R. Nutritional aspects in autoimmune diseases undergoing hematopoietic stem cell transplantation: overview and recommendations on behalf of the EBMT ADWP and Nurses Group. Front Nutr 2024; 11:1394518. [PMID: 38784130 PMCID: PMC11111942 DOI: 10.3389/fnut.2024.1394518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Autoimmune diseases (ADs) represent a heterogeneous group of conditions affecting 5-10% of the global population. In recent decades, hematopoietic stem cell transplant (HSCT), mainly autologous, has been successfully adopted to treat patients affected by severe/refractory ADs. In this context malnutrition has a detrimental impact on relapse, mortality, infection rate, engraftment, long-term survival, and prolongation of hospitalization. However, in this population, the management of nutrition should be improved since nutritional assessment is partially performed in routine clinical practice. A panel of nurses and physicians from the European Society for Blood and Marrow Transplantation (EBMT) reviewed all available evidence based on current literature and expert practices from centers with extensive experience in HSCT for ADs, on the nutritional management of ADs patients during HSCT procedure. In this context, adequate nutritional status predicts a better response to treatment and improves quality of life. Herein, a systematic and comprehensive monitoring of nutritional status before, during and after HSCT, with adequate nutritional support in the case of ADs patients, in addition to assessing the dietary requirements associated with HSCT has been covered. Moreover, given the singularity of each AD, the underlying disease should be considered for an appropriate approach. The management and evaluation of nutritional status must be carried out by a multidisciplinary team to assess the needs, monitor the effectiveness of each intervention, and prevent complications, especially in complex situations as patients affected by ADs.
Collapse
Affiliation(s)
- Chiara Gandossi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Helen Jessop
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Anne Hahn
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa Heininger
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Jörg Henes
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Alexia Marina Radaelli
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Carmagnola
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Morello
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Renica
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alice Bertulli
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Lazzari
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michelle Kenyon
- Department of Haematology, King's College Hospital, London, United Kingdom
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ariadna Domenech
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Raffaella Greco
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
|
9
|
Staxen CS, Andersen SE, Pedersen LM, Poulsen CB, Andersen JR. Nutrition and Lifestyle-Related Factors as Predictors of Muscle Atrophy in Hematological Cancer Patients. Nutrients 2024; 16:283. [PMID: 38257176 PMCID: PMC10819894 DOI: 10.3390/nu16020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cancer and side effects from cytostatic treatment commonly affect nutritional status manifested as a decrease in muscle mass. We aimed to investigate the impact of nutrition and lifestyle-related factors on muscle mass in patients with hematological cancer. METHODS Dietary intake, food preferences, quality of life (QoL), and physical activity level (PAL) were monitored during 1-2 cytostatic treatment series. Body composition was estimated using bioelectrical impedance analysis (BIA). RESULTS 61 patients were included. Weight loss and loss of muscle mass were detected in 64% and 59% of the patients, respectively. Muscle mass was significantly positively correlated to increasing PAL (p = 0.003), while negatively correlated to increasing age (p = 0.03), physical QoL (p = 0.007), functional QoL (p = 0.05), self-perceived health (p = 0.004), and self-perceived QoL (p = 0.007). Weight was significantly positively correlated to increased intake of soft drinks (p = 0.02) as well as the favoring of bitter grain and cereal products (p = 0.03), while negatively correlated to increasing age (p = 0.03) and increasing meat intake (p = 0.009) Conclusions: Several nutritional and lifestyle-related factors affected change in body composition. The clinical significance of these changes should be investigated in controlled, interventional studies.
Collapse
Affiliation(s)
- Christiane S. Staxen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Sara E. Andersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Lars M. Pedersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christian B. Poulsen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens R. Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| |
Collapse
|
|
10
|
Sauls R, Buro AW, Montgomery L, Stern M, Khimani F, Crowder SL. Nutritional status and body mass index before hematopoietic stem cell transplantation (HSCT) and associated outcomes: a rapid review. Support Care Cancer 2023; 32:50. [PMID: 38129689 PMCID: PMC11273956 DOI: 10.1007/s00520-023-08238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Hematopoietic stem cell transplantation (HSCT) recipients experience several post-HSCT complications affecting nutritional status, body mass index (BMI), and mortality that can potentially be mitigated by nutritional management. This rapid review examines the relationship between pre-HSCT nutritional status and BMI and post-HSCT survival. METHODS Articles were identified from PubMed, Scopus, and Embase. Two researchers independently completed the title, abstract, and full-text review. Inclusion criteria included the following: (1) randomized clinical trials or observational studies; (2) human subjects diagnosed with cancer and undergoing HSCT; (3) reported pre-HSCT nutritional status (e.g., diet recall, nutritional survey, dietitian session) or BMI; and (4) reported treatment related mortality and/or survival. RESULTS The initial search found 3036 articles, 28 were included in full-text review, and 18 met inclusion criteria. Articles had quasi-experimental (n = 2) and observational (n = 16) study designs. Of the studies, n = 5 reported nutritional intake decreased post-HSCT, and n = 2 reported nutrition intervention (i.e., controlled feeding) post-HSCT improved survival. Four studies reported having a BMI classified as underweight improved survival, while n = 5 reported having a BMI classified as overweight or obese improved survival. CONCLUSION Current research exploring the relationship between nutritional status and BMI with HSCT survival is mixed. Further research is needed to determine how nutritional status and BMI are associated withsurvival post-HSCT to inform future intervention work.
Collapse
Affiliation(s)
- Rachel Sauls
- College of Public Health, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Dr. Office 1214, Tampa, FL, 33612, USA
| | - Acadia W Buro
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Dr. Office 1214, Tampa, FL, 33612, USA
| | | | - Marilyn Stern
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Dr. Office 1214, Tampa, FL, 33612, USA
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Farhad Khimani
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Sylvia L Crowder
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Dr. Office 1214, Tampa, FL, 33612, USA.
| |
Collapse
|
|
11
|
Khosroshahi RA, Mohammadi H, Barkhordar M, Zeraattalab-Motlagh S, Imani H, Rashidi A, Sadeghi E, Wilkins S, Mousavi SA. Comparison of three malnutrition screening tools prior to allogeneic hematopoietic stem-cell transplantation. Front Nutr 2023; 10:1233074. [PMID: 37899838 PMCID: PMC10600464 DOI: 10.3389/fnut.2023.1233074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Previous studies have shown that malnutrition before hematopoietic stem cell transplantation (HSCT) is associated with poor patient prognoses. There is inconsistency among studies on which nutritional status screening tool is appropriate for malnutrition diagnosis before allo-HSCT. The present study aimed to compare nutritional screening tools in patients with leukemia before allo-HSCT. Methods An observational, cross-sectional, and single-center study was conducted in Tehran, Iran. One hundred four adults allo-HSCT candidates aged 18-55 years with leukemia were selected sequentially. Malnutrition assessment was done using three tools, the Global Leadership Initiative on Malnutrition (GLIM), nutritional risk screening 2002 (NRS-2002) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria. The agreement between malnutrition assessment tools was evaluated with Cohen's kappa. Results The agreement between GLIM and NRS-2002 was perfect (κ = 0.817, p < 0.001), while the agreement between GLIM and ESPEN was fair (κ = 0.362, p < 0.001). The agreement between NRS-2002 and ESPEN was fair (κ = 0.262, p < 0.001). We also found a moderate agreement for all tools (κ = 0.489, p < 0.001). Conclusion NRS-2002 is an accepted tool for screening malnutrition in hospitalized patients. In the current study, the GLIM criterion perfectly agreed with the NRS-2002. Further studies in the HSCT setting are needed to introduce a valid tool.
Collapse
Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Barkhordar
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirabbas Rashidi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sadeghi
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Simon Wilkins
- Cabrini Monash Department of Surgery, Cabrini Hospital, Melbourne, VIC, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC, Australia
| | - Seyed Asadollah Mousavi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
12
|
Pereira EY, Cannell PK, Cooney J, Wright M, Herrmann B, Purtill D. Bariatric surgery and allogeneic hematopoietic stem cell transplantation: a case series. Bone Marrow Transplant 2023; 58:1146-1148. [PMID: 37393405 DOI: 10.1038/s41409-023-02026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Affiliation(s)
| | - Paul Kenneth Cannell
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, Perth, WA, Australia
| | - Julian Cooney
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, Perth, WA, Australia
| | - Matthew Wright
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, Perth, WA, Australia
| | - Belinda Herrmann
- Dietetics Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Duncan Purtill
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, Perth, WA, Australia
| |
Collapse
|
|
13
|
Andersen S, Xu J, Llewellyn S, Kennedy G, Bauer J. Nutrition support and clinical outcomes following allogeneic stem cell transplantation. Bone Marrow Transplant 2023; 58:1137-1142. [PMID: 37542189 DOI: 10.1038/s41409-023-02080-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
Nutrition support is frequently required post allogeneic stem cell transplantation (SCT) and while there is some evidence on the benefits of enteral nutrition (EN), parenteral nutrition (PN) is widely used in practice. The study aimed to examine the impact of EN versus PN on early outcomes following SCT. All patients who underwent allogeneic SCT over 2.5 years were included in the analysis. Data was retrospectively collected on mode of nutrition support with clinical outcome data obtained from an existing database. Clinical outcomes were compared between groups by logistic, poisson and negative binomial regression, with adjustment for baseline confounders as appropriate. Patients who received EN then changed to PN had a longer length of hospital stay compared to those who received EN only (IR 1.24, 95% CI: 1.11-1.38, p < 0.001). Compared to those who received EN only, patients who received EN that changed to PN or PN only had a longer time to neutrophil engraftment (IR 1.11, 95% CI: 1.02-1.20, p = 0.016 and IR 1.16, 95% CI: 1.03-1.30, p = 0.017) and platelet engraftment (IR 1.20, 95% CI 1.08-1.33, p < 0.001 and IR 1.24, 95% CI 1.08-1.42, p = 0.002). Enteral nutrition should be first line nutritional support for patients undergoing allogeneic SCT.
Collapse
Affiliation(s)
- Sarah Andersen
- Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Jiani Xu
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Stacey Llewellyn
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - Glen Kennedy
- Department of Haematology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| |
Collapse
|
|
14
|
van Lieshout R, Tick LW, de Beer F, Koene HR, Regelink JC, Westerweel PE, de Witte MA, Beckers EAM, Schouten HC, Beijer S. Medical nutrition therapy during intensive remission-induction treatment and hematopoietic stem cell transplantation in acute myeloid leukemia patients: Hematologists' experiences and perspectives. Clin Nutr ESPEN 2023; 57:399-409. [PMID: 37739686 DOI: 10.1016/j.clnesp.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/09/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS The European Societies for Clinical Nutrition and Metabolism (ESPEN) and Blood and Marrow Transplantation (EBMT) recommend enteral nutrition (EN) as the first-choice medical nutrition therapy in acute myeloid leukemia (AML) patients undergoing intensive treatments, including high-dose remission-induction chemotherapy and hematopoietic stem cell transplantation (HSCT). However, parenteral nutrition (PN) remains the preferred method of nutrition support in current clinical practice. The aim of this qualitative study was to gain insight into hematologists' experiences and perspectives regarding the choice and ESPEN/EBMT recommendations on EN versus PN. METHODS Online semi-structured interviews were conducted with one hematologist from each of the 21 hospitals offering intensive AML treatments in the Netherlands, using Microsoft Teams. Interviews were audio-recorded, transcribed verbatim and thematically analyzed using Atlas. ti. One hundred nineteen hematologists working in the same hospitals were invited to complete a short online questionnaire survey (SurveyMonkey®) regarding their knowledge and opinion on the ESPEN/EBMT guidelines recommending EN over PN during intensive AML treatments. The results of this survey are presented in a descriptive way. RESULTS Fifty-nine hematologists participated in this study (42% overall response rate), of which 21 in the semi-structured interviews (response rate 100%) and 38 in the online survey (response rate 32%). Hematologists considered medical nutrition therapy important for prevention and treatment of malnutrition and associated adverse outcomes in AML patients undergoing intensive remission-induction treatment and HSCT. However, opposed to the ESPEN/EBMT guidelines, the vast majority of hematologists were hesitant or reluctant to use EN instead of PN as the first-choice medical nutrition therapy in these patients. The most frequently cited barriers to use EN were the expected low feasibility and tolerance of EN, feeding tube-related discomfort and bleeding risk, and patient refusal. Other barriers to follow the guidelines on EN were related to personal factors, including hematologists' knowledge (lack of awareness and familiarity) and attitude (lack of agreement, outcome expectancy, experience, success, motivation, and learning culture), guideline-related factors (lack of evidence and applicability), and external factors (lack of collaboration and resources). Facilitators included strategies for nutrition education and dissemination of nutritional guidelines, interprofessional and patient collaboration, availability of feeding tubes that can be inserted without endoscopy and stronger scientific evidence. CONCLUSIONS Hematologists recognized the importance of medical nutrition therapy for reducing malnutrition and related negative outcomes during intensive AML treatments. However, contrary to the ESPEN/EBMT guidelines, they preferred PN instead of EN as the medical nutrition therapy of first choice. To reduce compliance barriers, interventions should focus on improving hematologists' knowledge of medical nutrition therapy and dietary guidelines, enhancing success rates of EN by adequately triaging patients eligible for EN and inserting duodenal feeding tubes using an electromagnetic sensing device without endoscopy, developing decision aids and multidisciplinary guidelines and care pathways. Furthermore, future trials should focus on the feasibility and benefits of EN versus PN both during remission-induction treatment and HSCT.
Collapse
Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, Veldhoven, 5504 DB, The Netherlands.
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, Veldhoven, 5504 DB, The Netherlands
| | - Fenne de Beer
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, Veldhoven, 5504 DB, The Netherlands
| | - Harry R Koene
- Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, The Netherlands
| | - Josien C Regelink
- Department of Internal Medicine, Meander Medical Center, Maatweg 3, Amersfoort, 3813 TZ, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, 3318 AT, The Netherlands
| | - Moniek A de Witte
- Department of Internal Medicine, University Medical Center Utrecht, Division Hematology, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, Maastricht University Medical Center, Maastricht, 6229 HX, The Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, Maastricht University Medical Center, Maastricht, 6229 HX, The Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, Utrecht, 3511 DT, The Netherlands
| |
Collapse
|
|
15
|
Liu J. Re: Growth and Nutritional Outcomes in Children Post-haematopoietic Stem Cell Transplant Without Exposure to Total Body Irradiation. Clin Oncol (R Coll Radiol) 2023; 35:e263. [PMID: 36517317 DOI: 10.1016/j.clon.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Affiliation(s)
- J Liu
- Department of Hematology, The First People's Hospital of Yunnan Province, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
| |
Collapse
|
|
16
|
Broglie L, Friend BD, Chhabra S, Logan BR, Bupp C, Schiller G, Savani BN, Stadtmauer E, Abraham AA, Aljurf M, Badawy SM, Perez MAD, Guinan EC, Hashem H, Krem MM, Lazarus HM, Rotz SJ, Wirk B, Yared JA, Pasquini M, Thakar MS, Sorror ML. Expanded HCT-CI Definitions Capture Comorbidity Better for Younger Patients of Allogeneic HCT for Nonmalignant Diseases. Transplant Cell Ther 2023; 29:125.e1-125.e9. [PMID: 36442768 PMCID: PMC9911359 DOI: 10.1016/j.jtct.2022.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) can cure many nonmalignant conditions, but concern for morbidity and mortality remains. To help physicians estimate patient-specific transplant mortality risk, the HCT comorbidity index (HCT-CI) is used. However, pediatric physicians use the HCT-CI less frequently than adult counterparts. We used the Center for International Blood and Marrow Transplant Research database to expand the HCT-CI comorbidity definitions to be more inclusive of children and adolescent and young adult (AYA) patients, adding history of mechanical ventilation, history of invasive fungal infection, assessment of chronic kidney disease (CKD) by estimated glomerular filtration rate, expanding the definition of obesity, and adding an underweight category. A total of 2815 children and AYAs (<40 years old) who received first allogeneic HCT for nonmalignant diseases from 2008 to 2017 were included to create an expanded youth nonmalignant HCT-CI (expanded ynHCT-CI) and a simplified non-malignant (simplified ynHCT-CI) HCT-CI. The expanded comorbidities occurred frequently-history of mechanical ventilation (9.6%), history of invasive fungal infection (5.9%), mild CKD (12.2%), moderate/severe CKD (2.1%), obesity (10.9%), and underweight (14.5%). Thirty-nine percent of patients had an increase in their comorbidity score using the expanded ynHCT-CI, leading to a redistribution of scores: ynHCT-CI score 0 (35%), 1-2 (36.4%), and ≥3 (28.6%). Patients with an increase in their comorbidity score had an increased hazard of mortality compared to those whose score remained the same (hazard ratio = 1.41; 95% confidence interval, 1.01-1.98). Modifications to the HCT-CI can benefit children and AYA patients with nonmalignant diseases, creating a risk assessment tool that is clinically relevant and better captures comorbidity in this younger population.
Collapse
Affiliation(s)
- Larisa Broglie
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D Friend
- Baylor College of Medicine, Center for Cell and Gene Therapy, Houston, Texas
| | - Saurabh Chhabra
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Brent R Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caitrin Bupp
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Gary Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Allistair A Abraham
- Center for Cancer and Immunology Research, Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, District of Columbia
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Eva C Guinan
- Departments of Pediatric and Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | | | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Jean A Yared
- Transplantation & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Marcelo Pasquini
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Monica S Thakar
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
|
17
|
Friend BD, Broglie L, Logan BR, Chhabra S, Bupp C, Schiller G, Beitinjaneh A, Perez MAD, Guilcher GMT, Hashem H, Hildebrandt GC, Krem MM, Lazarus HM, Nishihori T, Nusrat R, Rotz SJ, Wirk B, Wieduwilt M, Pasquini M, Savani BN, Stadtmauer EA, Sorror ML, Thakar MS. Adapting the HCT-CI Definitions for Children, Adolescents, and Young Adults with Hematologic Malignancies Undergoing Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023; 29:123.e1-123.e10. [PMID: 36442769 PMCID: PMC9911376 DOI: 10.1016/j.jtct.2022.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Allogeneic hematopoietic cell transplantation is a curative procedure for hematologic malignancies but is associated with a significant risk of non-relapse mortality (NRM). The Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) is a prognostic tool that discriminates this risk in all age groups. A recent survey of transplant physicians demonstrated that 79% of pediatric providers used the HCT-CI infrequently, and most reported concerns about its applicability in the younger population. We conducted a retrospective study using the Center for International Blood and Marrow Transplant Research database to examine the impact of expanded HCT-CI definitions on NRM in pediatric and young adult patients with hematologic malignancies. We included 5790 patients <40 years old receiving allogeneic transplants between 2008 and 2017 to examine broader definitions of comorbidities in the HCT-CI, including history of mechanical ventilation and fungal infection, estimated glomerular filtration rate, and body mass index (BMI) percentiles. Multivariable Fine-Gray models were created to determine the effect of each HCT-CI defining comorbidity and its modification on NRM and were used to develop 2 novel risk scores. We next developed the expanded HCT-CI for children and young adults (youth with malignancies; expanded ymHCT-CI), where 23% patients had an increased comorbidity score, compared to the HCT-CI. Comorbidities with hazard ratio < 1.2 were then removed to create the simplified HCT-CI for children and young adults (youth with malignancies; simplified ymHCT-CI), which demonstrated higher scores corresponded to a greater risk of NRM (P < .001). These novel comorbidity indexes with broader definitions are more relevant to pediatric and young adult patients, and prospective studies are needed to validate these in the younger patient population. It remains to be seen whether the development of these pediatric-specific and practical risk indexes increases their use by the pediatric transplant community.
Collapse
Affiliation(s)
- Brian D Friend
- Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | - Larisa Broglie
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Caitrin Bupp
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Gary Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Gregory M T Guilcher
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, Florida
| | | | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Matthew Wieduwilt
- Department of Medicine, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Marcelo Pasquini
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward A Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Monica S Thakar
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
|
18
|
Jefferis M, Andersen S, Brown T, Curley C, Bauer J. Malnutrition and clinical outcomes post alloSCT. J Hum Nutr Diet 2022. [PMID: 36511299 DOI: 10.1111/jhn.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malnutrition has been linked with higher risk of poor outcomes post-allogeneic stem cell transplantation (alloSCT); however, few studies have used a validated nutrition assessment tool such as the Patient Generated Subjective Global Assessment (i.e., PG-SGA) to measure nutritional status and investigate associations with long-term clinical outcomes. The present study aimed to assess the incidence of malnutrition prior to alloSCT and determine whether there was an association between nutritional status pre-transplant and post-transplant clinical outcomes including acute kidney injury, graft-versus-host disease, intensive care admission, need for haemodialysis and survival. METHODS A retrospective analysis of 362 patients (213 males:149 females, mean ± SD age = 47.8 ± 14.1 years) who underwent alloSCT from 2008 to 2013 was conducted. Data on clinical outcomes were obtained for 5 years post-transplant. RESULTS Fifteen percent (n = 56) of patients were identified as malnourished pre-admission. Malnutrition was associated with longer hospital stay (p = 0.007), increased requirement for haemodialysis (p = 0.016) and increased admissions to the intensive care unit (p = 0.003). There was no association between malnutrition and acute kidney injury, graft-versus-host disease or survival. Following multivariate analyses, malnutrition remained significantly associated with increased admission rates to the intensive care unit (odds ratio = 3.8, 95% confidence interval = 1.3-10.5, p = 0.011) and increased length of hospital stay > 30 days (odds ratio = 3.6. 95% confidence interval = 1.8-7.4, p ≤ 0.001). CONCLUSIONS These findings add importance to the need for nutrition screening and assessment to be routinely undertaken for patients prior to alloSCT and throughout hospitalisation to provide early nutrition intervention for the prevention of malnutrition, poor clinical outcomes and increased healthcare costs.
Collapse
Affiliation(s)
- Madison Jefferis
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Sarah Andersen
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Cameron Curley
- Department of Haematology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
|
19
|
Orvain C, Byelykh M, Othus M, Sandmaier BM, Schoch G, Davis C, Appelbaum FR, Walter RB. Relationship Between Pretransplantation Nutritional Status and Outcome in Adults with Acute Myelogenous Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:846.e1-846.e9. [PMID: 36179985 PMCID: PMC9729404 DOI: 10.1016/j.jtct.2022.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022]
Abstract
Pretransplantation nutritional status may impact outcome after allogeneic hematopoietic cell transplantation (HCT). Various simple screening tools have been developed and used to identify patients at risk of malnutrition; however, how best to use these screening tools is unclear, and their accuracy for the prediction of adverse outcomes is unknown. To investigate how these different measures contribute to outcome prediction, we examined a large cohort of adults with acute myelogenous leukemia (AML) who underwent allogeneic HCT in first or second remission at our institution between April 2006 and May 2021. We assessed the prognostic role of the Nutrition Risk Index (NRI), which combines weight loss and serum albumin, in 970 adults with AML in first or second remission who had usual body weight information available at AML diagnosis or relapse and before HCT. A low NRI at the time of conditioning for HCT was associated with higher nonrelapse mortality (hazard ratio [HR], .97; 95% confidence interval [CI], .95 to .98; P < .001) and relapse risk (HR, .98; 95% CI, .96 to .99; P < .001) and decreased relapse-free survival (HR, .97; 95% CI, .96 to .98; P < .001) and overall survival (HR, .97; 95% CI, .96 to .98; P < .001), as was a low pre-HCT serum albumin level. After multivariable adjustment, NRI, but not weight loss alone, was associated with outcome. The predictive ability of NRI was overall relatively low and comparable to that of serum albumin, with a C-statistic not exceeding .59. Taken together, our data indicate that pre-HCT level of serum albumin, an acute-phase protein recognized to more accurately reflect the severity of the inflammatory response compared with poor nutritional status, but not weight loss, is independently associated with post-HCT outcome in patients with AML. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
Collapse
Affiliation(s)
- Corentin Orvain
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington; Department of Blood Diseases, Angers University Hospital, Angers, France; Grand Ouest Against Leukemia (GOAL), Angers, France; University of Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Angers, France
| | - Mariia Byelykh
- Nutrition Therapy, University of Washington Medical Center, Seattle, Washington
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Gary Schoch
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Chris Davis
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| |
Collapse
|
|
20
|
Cioce M, Botti S, Lohmeyer FM, Galli E, Magini M, Giraldi A, Garau P, Celli D, Zega M, Sica S, Bacigalupo A, De Stefano V, Borrelli I, Moscato U. Nutritional status and quality of life in adults undergoing allogeneic hematopoietic stem cell transplantation. Int J Hematol 2022; 116:266-275. [PMID: 35532878 PMCID: PMC9314297 DOI: 10.1007/s12185-022-03351-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/07/2023]
Abstract
Although the effects of malnutrition on morbidity and mortality in adult patients undergoing allogeneic hematopoietic stem cell transplantation are clear, the relationship with quality of life (QOL) is less clear. The purpose of this study was to assess the relationship between malnutrition and QOL. A prospective observational study was conducted in 36 adult patients undergoing allogeneic hematopoietic stem cell transplantation. Adapted criteria of the Global Leadership Initiative on malnutrition have been used for the diagnosis of malnutrition in clinical settings. A cancer linear analog scale was used to assess QOL. Overall QOL at 14 days after allogeneic hematopoietic stem cell transplantation was 37.1 (95% CI 2.9–45.39) in patients without severe malnutrition, versus 16.0 (95% CI − 6.6 to 38.6) in patients with severe malnutrition (p = 0.05). At discharge, it was 48.0 (95% CI 38.4–57.6) versus 34.0 (95% CI 4.1–63.9) (p = 0.27). The results of our study suggest that patients with severe malnutrition at discharge tend to have worse QOL. A larger cohort of patients is required to confirm this hypothesis.
Collapse
Affiliation(s)
- Marco Cioce
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Stefano Botti
- Haematology Unit, Oncology and Advanced Technology Department, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Eugenio Galli
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Marinella Magini
- UOC Clinical Nutrition, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Giraldi
- UOC Clinical Nutrition, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paola Garau
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Danilo Celli
- Faculty of Medicine and Psychology, Università "La Sapienza", Rome, Italy
| | - Maurizio Zega
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Simona Sica
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy.
| | - Andrea Bacigalupo
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan Borrelli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Moscato
- Department of Health Science of Woman and Child and Public Health-Occupational Health and Hygiene, Area-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
|
21
|
van Lieshout R, Lize N, Tick LW, van Deursen J, Driessen E, Janssen T, Custers S, Kranenburg S, van der Lee D, Koene HR, Beckers EAM, Schouten HC, Beijer S. Nutrition-related problems, nutritional support practices and barriers to adherence to nutritional guidelines during intensive treatment for acute myeloid leukemia: Patients' and hematology nurses' perspectives and experiences. Clin Nutr ESPEN 2022; 48:446-455. [PMID: 35331527 DOI: 10.1016/j.clnesp.2021.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS The updated guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) and for Blood and Marrow Transplantation (EBMT) on nutrition in intensively treated acute myeloid leukemia (AML) patients recommend enteral nutrition (EN) instead of parenteral nutrition (PN) as the first-choice medical nutrition therapy. Despite this, PN remains the preferred route of nutrition administration in daily practice. The aim of this qualitative study was to gain insight into the patients' and hematology nurses' experiences and perceptions regarding nutritional problems and nutritional support and the reasons for the low adherence to the ESPEN/EBMT guidelines. METHODS Semi-structured interviews were conducted in 23 patients from various Dutch hospitals who had completed intensive AML treatment. Interviews with 22 patients were audio-recorded and transcribed, one interview was summarized. The transcripts and summary were thematically analyzed using Atlas.ti. From each of the 22 Dutch hospitals providing intensive AML treatment, one hematology nurse participated in a telephone questionnaire survey. The results of this survey are presented in a descriptive way. RESULTS Nutritional problems were a major source of distress in most participating patients. Nutritional support often led to peace of mind and less concerns, provided that there were no conflicting nutritional support practices among treating hospitals. Patients perceived PN and EN as a life-line and necessary for the prevention of or recovery from physical decline, but they also experienced loss of independence, limited mobility, fear of unwanted body weight gain and problems related to the feeding equipment. Both patients and hematology nurses regarded PN as an easy method of nutrition administration, while EN was often seen as a necessary evil or was even refused by patients, owing to tube-related physical discomfort and EN intolerance. Both patients' and hematology nurses' reluctance to administer EN proved to be barriers to the ESPEN/EBMT nutritional guideline adherence. Among the surveyed hematology nurses, barriers to adherence included personal factors related to their knowledge (lack of awareness) and attitudes (negative outcome expectancy and lack of agreement), guideline-related factors (lack of evidence) and external factors (lack of collaboration). CONCLUSION Individualized nutritional support, including EN and PN, may reduce nutrition-related distress in intensively treated AML patients, provided that conflicting nutritional support practices among hospitals are avoided or explained. The barriers to adherence to the ESPEN/EBMT guidelines on EN and PN in this patient group may be reduced by enhancing hematology nurses' awareness and knowledge of the guidelines, incorporating the guidelines into multidisciplinary clinical pathways, improving outcome of EN by proper triage of patients eligible for EN and increasing the level of evidence of the guidelines.
Collapse
Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Nora Lize
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Judith van Deursen
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Eline Driessen
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Tina Janssen
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Stephanie Custers
- Department of Dietetics and Nutrition, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Suzanne Kranenburg
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Debbie van der Lee
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Harry R Koene
- Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
| |
Collapse
|
|
22
|
Szeja N, Grosicki S. Nutritional status of patients with lymphoproliferative neoplasms before and after the first-line treatment. Expert Rev Hematol 2022; 15:83-91. [PMID: 35099347 DOI: 10.1080/17474086.2022.2035717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Nutritional disorders in cancer patients, including lymphoproliferative neoplasms, occur with varying frequency. OBJECTIVES The primary aim of the study was to analyze the changes in the nutritional status of patients with lymphoproliferative neoplasms following first-line chemotherapy. MATERIALS AND METHODS 46 patients, with a median age of 62 years, participated in a prospective single-center study. Their demographic, biochemical and clinical features were analyzed. The study consisted of several stages that were conducted at two time points. P values < 0.05 were considered statistically significant. RESULTS The study included patients with multiple myeloma (48%), non-Hodgkin's lymphoma (28%) or chronic lymphocytic leukemia (24%). After the end of the first-line chemotherapy, a decrease in the concentration of albumin (p = 0.04), transferrin (p = 0.38) and total cholesterol (p = 0.76) were found. Statistically greater unintended weight loss occurred before treatment initiation (p < 0.001). Moreover, a significant decrease in the mean values of the phase angle (p < 0.01) was noted. CONCLUSIONS Most patients before the oncological therapy did not show clinical or biochemical symptoms of malnutrition. However, after the treatment was completed, the parameters of the nutritional status showed its deterioration.
Collapse
Affiliation(s)
- Nicola Szeja
- Department of Hematology and Cancer Prevention, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice
| |
Collapse
|
|
23
|
Price S, Kim Y. Body Composition Impacts Hematopoietic Stem Cell Transplant Outcomes in Both Autologous and Allogeneic Transplants: A Systematic Review. Nutr Cancer 2021; 74:2731-2747. [PMID: 34963380 DOI: 10.1080/01635581.2021.2020303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
According to World Health Organization, over 50,000 hematopoietic stem cell transplants (HSCTs) are performed annually worldwide. Though HSCT can extend life-expectancy and improve disease-related health burdens, it is not without risks. Post-transplant overall survival is improving; therefore, it is imperative that factors contributing to or impeding further improvements are well understood. The purpose of this systematic review is to explore current data on body composition (specifically weight loss, BMI, obesity and sarcopenia) and the relation to HSCT outcomes. A literature search was conducted via PubMed and Web of Science databases. Key words included "body composition," "sarcopenia," "hematopoietic stem cell transplant," "malnutrition," "body mass index," and "obesity." Results indicated that 16 out of 18 analyzed studies found a statistically significant relationship between body composition, in particular higher BMI and weight loss, and at least one survival-related outcome variable (eg., non-relapse mortality, overall survival and/or relapse). Based on the findings of this review, body composition, whether evaluated before or during HSCT, can impact a wide variety of post-transplant outcomes. This speaks to the importance of evaluating patients pre-transplant, identifying potential risk factors for worsened outcomes, and providing immediate interventions in order to optimize transplant outcomes.
Collapse
Affiliation(s)
- Sarah Price
- Nutrition and Dietetics, Central Michigan University, Mt. Pleasant, Michigan, USA
| | - Yeonsoo Kim
- Nutrition and Dietetics, Central Michigan University, Mt. Pleasant, Michigan, USA
| |
Collapse
|
|
24
|
Akbulut G, Yesildemir O. Overview of nutritional approach in hematopoietic stem cell transplantation: COVID-19 update. World J Stem Cells 2021; 13:1530-1548. [PMID: 34786156 PMCID: PMC8567455 DOI: 10.4252/wjsc.v13.i10.1530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
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.
Collapse
Affiliation(s)
- Gamze Akbulut
- Department of Nutrition and Dietetics, Gazi University, Faculty of Health Sciences, Ankara 06490, Turkey.
| | - Ozge Yesildemir
- Department of Nutrition and Dietetics, Gazi University, Faculty of Health Sciences, Ankara 06490, Turkey
| |
Collapse
|
|
25
|
Malnutrition risk prior to hematopoietic stem cell transplantation predicts mortality in adults. Bone Marrow Transplant 2021; 56:2268-2271. [PMID: 33846560 DOI: 10.1038/s41409-021-01292-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 02/05/2023]
Abstract
Patients with hematological malignancies have a high risk of developing malnutrition. Few data are currently available that illustrate the impact of the patients' nutritional status prior to HSCT on their outcome. The aim of this study was to investigate the association between the patients' malnutrition status prior to receiving autologous or allogeneic HSCT and mortality in adults with hematological malignancies. We conducted a retrospective cohort study including 341 patients. Survival curves and Cox proportional-hazards models were used to reveal whether malnutrition risk served as a predictor for the overall mortality and non-relapse mortality. The survival curves revealed that patients with malnutrition risk prior to HSCT had an increased risk of death during the 1-year follow-up period (overall mortality as well as non-relapse mortality). This result was confirmed by the Cox regression models, which showed a mortality risk that is more than two times higher in patients at risk of malnutrition. In allogeneic transplant patients, the impact of malnutrition risk on mortality was even higher. Our conclusions presuppose that nutrition is an important factor during the holistic treatment of HSCT patients by all healthcare professionals involved in the care of this patient group. Future studies should be carried out to examine how and whether different nutritional interventions effectively improve the nutritional status of this patient group.
Collapse
|
|
26
|
Bossi P, Delrio P, Mascheroni A, Zanetti M. The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review. Nutrients 2021; 13:1980. [PMID: 34207529 PMCID: PMC8226689 DOI: 10.3390/nu13061980] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022] Open
Abstract
Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population.
Collapse
Affiliation(s)
- Paolo Bossi
- Medical Oncology Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Giovanni Pascale IRCCS-Italia, 80131 Naples, Italy
| | - Annalisa Mascheroni
- Clinical Nutrition and Dietetics Unit, ASST Melegnano-Martesana, 20077 Melegnano, Italy
| | - Michela Zanetti
- Department of Medical Sciences, University of Trieste, 34100 Trieste, Italy
| |
Collapse
|
|
27
|
Nutritional Status at Diagnosis and Pre-transplant Weight Loss Impact Outcomes of Acute Myeloid Leukemia Patients Following Allogeneic Stem Cell Transplantation. Hemasphere 2021; 5:e532. [PMID: 33615146 PMCID: PMC7886498 DOI: 10.1097/hs9.0000000000000532] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
The nutritional status at diagnosis, as well as weight loss during chemotherapy, are important factors for morbidity and mortality in cancer patients. They might also influence outcomes in patients with acute myeloid leukemia (AML) receiving allogeneic hematopoietic stem cell transplantation (HSCT). We evaluated the body mass index (BMI) at diagnosis, prior to HSCT, and the BMI difference (ΔBMI = BMIHSCT–BMIdiagnosis) in 662 AML patients undergoing allogeneic HSCT. Patients being obese at AML diagnosis had significantly higher nonrelapse mortality (NRM) and shorter overall survival (OS) after HSCT, but no distinct cumulative incidence of relapse than nonobese patients. Weight loss during chemotherapy (ΔBMI > –2) was a strong predictor for higher NRM and shorter OS in univariate and multivariate analyses. These results were observed across all European LeukemiaNet (ELN) 2017 risk groups but especially in patients with favorable or intermediate ELN2017 risk and patients transplanted in morphologic complete remission. Only in patients being obese at AML diagnosis, weight loss did not result in adverse outcomes. ΔBMI > –2 represents a strong, independent, and modifiable risk factor for AML patients treated with HSCT. Nutritional monitoring and supplementation during disease course might improve patients’ outcomes.
Collapse
|
|
28
|
Optimization of nutrition support practices early after hematopoietic cell transplantation. Bone Marrow Transplant 2020; 56:314-326. [PMID: 33040076 DOI: 10.1038/s41409-020-01078-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 01/04/2023]
Abstract
Nutrition support is often required during hematopoietic cell transplant (HCT) given the gastrointestinal toxicity that frequently precludes adequate protein-calorie intake. This article reviews the latest evidence for enteral versus parenteral nutrition in the adult and pediatric HCT population and addresses key considerations as well as barriers to implement this in practice. Registered Dietitian Nutritionists are key members of the interdisciplinary team to proactively manage enteral nutrition support to provide timely, adequate protein and calories to help prevent malnutrition, loss of lean body mass, and functional decline as well as provide evidence-based diet recommendations. This article also reviews emerging research supporting the role of luminal nutrients to maintain microbiotal diversity.
Collapse
|
|
29
|
Eglseer D, Seymann C, Lohrmann C, Hoedl M. Nutritional problems and their non-pharmacological treatment in adults undergoing haematopoietic stem cell transplantation-A systematic review. Eur J Cancer Care (Engl) 2020; 29:e13298. [PMID: 32862488 PMCID: PMC7757254 DOI: 10.1111/ecc.13298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/16/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022]
Abstract
Objective This systematic review aimed to identify the most relevant problems related to malnutrition in adult patients undergoing haematopoietic stem cell transplantation (HSCT) and to identify non‐pharmacological interventions to treat these problems. Methods A systematic search for each research question was performed in MEDLINE, CINAHL, Embase, the Cochrane Library, Google Scholar and reference lists in the period 2009–2019. Results Six and nine studies were included respectively. Quantitative pooling of data was not possible due to the heterogeneity of the studies. Oral mucositis (OM), nausea/vomiting, diarrhoea and dysgeusia were the most frequently reported nutritional problems. Cryotherapy and laser therapy seem to be effective in the prevention and treatment of OM. Recommendations for or against the use of mouth rinses and light therapy in the treatment of OM cannot be made, as too few studies have been conducted in this area. The evidence for non‐pharmacological treatment options in the case of nausea/vomiting and diarrhoea is rather limited. No study was identified with regard to treatment of dysgeusia. Conclusion Nutrition in HSCT patients has not yet been studied to a satisfactory extent. There is an urgent need for high‐quality studies to be conducted in this area to optimise the care of patients undergoing haematopoietic stem cell transplantation.
Collapse
Affiliation(s)
- Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Carola Seymann
- Department of Internal Medicine, HaematologyUniversity Hospital of Graz, Graz, Austria
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Manuela Hoedl
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| |
Collapse
|
|
30
|
Botti S, van der Werf S, Stringer J, Eeltink C, Murray J, Ciceri F, Babic A, Duarte RF, Labopin M, Peczynski C, Basak GW, Liptrott SJ. Nutritional support in stem cell transplantation programs: Results from a multicenter survey of nurses on behalf of the Nurses Group and Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation and the Gruppo Italiano Trapianto di Midollo Osseo. Nutrition 2020; 79-80:110998. [PMID: 32987334 DOI: 10.1016/j.nut.2020.110998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/08/2020] [Accepted: 08/15/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Malnutrition in patients undergoing hematopoietic stem cell transplant (HSCT) can develop rapidly without appropriate nutritional support and affect morbidity and mortality. Guidance to monitor and manage nutrition status is described within the literature; however, whether this is applied in clinical practice is unclear. METHODS This paper describes a cross-sectional survey to explore current practice approaches in nutrition support management and adherence to international guidelines. RESULTS A total of 108 nurses from 108 centers across 16 countries replied to the questionnaire. A significant variation was observed regarding the availability of documents supporting the monitoring and management of nutrition status, application of recommendations, and nutritional practices. DISCUSSION The findings revealed that country was the most important factor influencing the differences in practice; however, significant differences were also observed based on patient age group (pediatrics vs. adults), department composition (hematology + HSCT unit vs. HSCT unit alone), and availability of nutrition health care professionals. Behavioral differences regarding nutritional practice approaches could be indicative of differences in knowledge or subject awareness, as well as a reflection of diversity across health care system policies. CONCLUSIONS Guideline dissemination and raising awareness through educational campaigns are suggested approaches to improve health care professionals' knowledge and sensitivity to this important topic.
Collapse
Affiliation(s)
- Stefano Botti
- Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy.
| | | | - Jacqui Stringer
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Corien Eeltink
- Cancer Center Amsterdam, Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - John Murray
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Aleksandra Babic
- Hemato-Oncology Unit, IOSI-Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Rafael F Duarte
- Hematopoietic Transplantation and Hemato-Oncology Section, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Myriam Labopin
- Department of Hematology and Cell Therapy and EBMT Paris Office, Hôpital Saint-Antoine APHP, Saint Antoine, France
| | - Christophe Peczynski
- Department of Hematology and Cell Therapy and EBMT Paris Office, Hôpital Saint-Antoine APHP, Saint Antoine, France
| | - Grzegorz Wladyslaw Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
|
31
|
van Lieshout R, Tick LW, de Laat D, Custers S, Dekker IM, Douma MD, Kalter D, Kranenburg S, van der Lee D, Rhoon-Bruijnzeel P, Schlösser I, Somer M, van Tilborg CJ, Visser WK, Schouten HC, Beijer S. Adherence to guidelines on nutrition support during intensive treatment of acute myeloid leukemia patients: A nationwide comparison. Clin Nutr ESPEN 2020; 39:242-250. [PMID: 32859324 DOI: 10.1016/j.clnesp.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS The level of adherence to the updated guidelines of The European Societies for Clinical Nutrition and Metabolism (ESPEN) and for Blood and Marrow Transplantation (EBMT) on nutrition in intensively treated adult acute myeloid leukemia (AML) patients in clinical practice is unknown. The aim of this nationwide survey was to investigate ESPEN/EBMT nutritional guideline adherence during intensive AML treatment, variation in nutrition support practices among hospitals and whether these practices changed after guideline publication. METHODS All 22 Dutch hospitals providing (aftercare following) high-dose chemotherapy and/or hematopoietic stem cell transplantation for adult AML patients were surveyed on nutrition support practices during these intensive AML treatments. We used an online questionnaire in 2015 and semi-structured telephone interviews in 2018-2019. Both surveys were completed by registered dieticians and addressed the use of enteral (EN) and parenteral (PN) nutrition. The ESPEN/EBMT nutritional guideline adherence was investigated through the telephone interviews. RESULTS High-level ESPEN/EBMT guideline adherence and/or uniformity among hospitals regarding nutrition support practices during intensive AML treatment were observed for nutritional screening, -aims, safe food handling and exercise training. Adherence to ESPEN/EBMT recommendations that were not implemented into national guidelines, including nutritional assessment and use of medical nutrition, was poor. All hospitals assessed nutritional intake, -impact symptoms and body weight, but muscle mass, physical performance and degree of systemic inflammation were rarely and variably monitored. Although the number of hospitals using EN as first-choice nutritional intervention increased from 3 hospitals in 2015 to 8 in 2019, PN remained the preferred method of nutrition support. Furthermore, the timing of medical nutrition varied. CONCLUSIONS Although the use of EN increased after publication of the updated ESPEN/EBMT nutritional guidelines, adherence to these standards was limited and there was heterogeneity in nutrition support practices during intensive AML treatment among hospitals. Incorporating international nutritional standards into national guidelines by nutrition expert groups immediately upon publication may improve adherence.
Collapse
Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Daphne de Laat
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Stephanie Custers
- Department of Dietetics and Nutrition, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Ingeborg M Dekker
- Department of Dietetics and Nutrition, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Madieke D Douma
- Department of Dietetics and Nutrition, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Doris Kalter
- Department of Gastroenterology and Hepatology - Dietetics and Intestinal Failure, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Suzanne Kranenburg
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Debbie van der Lee
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Patricia Rhoon-Bruijnzeel
- Department of Dietetics and Nutrition, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Ien Schlösser
- Department of Dietetics and Nutrition, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Maaike Somer
- Department of Dietetics and Nutrition, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Claudia J van Tilborg
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Willy K Visser
- Department of Dietetics and Nutrition, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Section Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
| |
Collapse
|
|
32
|
Van de Louw A, Zhu X, Frankenfield D. Obesity and malnutrition in critically ill patients with acute myeloid leukemia: Prevalence and impact on mortality. Nutrition 2020; 79-80:110956. [PMID: 32862120 DOI: 10.1016/j.nut.2020.110956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/04/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Obese patients have an increased risk of developing acute myeloid leukemia (AML), which in turn predisposes to malnutrition. Obesity has been associated with improved survival in critically ill patients (obesity paradox), but this effect seems to disappear when adjusting for malnutrition. How obesity and malnutrition interplay to affect mortality in critically ill patients with AML has not been addressed and was the objective of this study. METHODS This was a retrospective chart review of adult patients with AML who were admitted to the medical intensive care unit and had a nutrition consultation between 2011 and 2018. Demographic characteristics, comorbidities, severity scores, and laboratory parameters, as well as data on vital organ support, hospital mortality, and long-term survival were collected. Obesity was defined by a body mass index of ≥30 kg/m2 and malnutrition per the American Society for Parenteral and Enteral Nutrition criteria. Patients were compared based on nutrition and weight status, and hospital and long-term mortality were analyzed with logistic regression and Kaplan-Meier curves. RESULTS We included 145 patients (57% obese, 30% malnourished) in the study. As time from AML diagnosis elapsed, obesity was less frequent and malnutrition more prevalent, with 25% of obese patients also presenting with malnutrition. Hospital mortality was 40% and associated with malnutrition in nonobese patients (odds ratio: 5.1; 95% confidence interval, 1.3-21.8; P = 0.02) and sequential organ failure assessment severity score (odds ratio: 1.5; 95% confidence interval, 1.3-1.7; P < 0.0001). Sensitivity analyses confirmed the association between malnutrition, but not obesity, and hospital mortality. Obese malnourished patients had lower long-term survival, but this was not significant (P = 0.25). CONCLUSIONS Critically ill patients with AML have a high prevalence of malnutrition and obesity, which are sometimes associated. Malnutrition, but not obesity, was associated with hospital mortality.
Collapse
Affiliation(s)
- Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State Health Hershey Medical Center, Hershey, Pennsylvania.
| | - Xijun Zhu
- Division of Pulmonary and Critical Care Medicine, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - David Frankenfield
- Department of Clinical Nutrition, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
|
33
|
Lazarow H, Singer R, Compher C, Gilmar C, Kucharczuk CR, Mangan P, Salam K, Cunningham K, Stadtmauer EA, Landsburg DJ. Effect of malnutrition-driven nutritional support protocol on clinical outcomes in autologous stem cell transplantation patients. Support Care Cancer 2020; 29:997-1003. [PMID: 32556621 DOI: 10.1007/s00520-020-05571-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/11/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Poor nutrition status in patients receiving high-dose chemotherapy and autologous stem cell transplant (ASCT) has been associated with inferior clinical outcomes. We aim to determine whether a malnutrition-driven nutritional support protocol can improve these outcomes. METHODS In this prospective cohort study, we assessed adults for malnutrition who were consecutively admitted for ASCT between October 2017 and March 2019 (n = 251), and provided enteral or parenteral nutrition (EN/PN) to patients who were malnourished early in the transplantation admission. We compared their clinical outcomes with those of a historical cohort admitted between May 2016 and October 2017 (n = 257) for whom nutrition assessment and initiation of EN/PN were not protocol-driven. RESULTS Patients receiving ASCT during the intervention period experienced decreased odds of prolonged hospital stay (p = 0.023), central line-associated bloodstream infection (p = 0.015), mucosal barrier injury (p = 0.037), and high weight loss (p = 0.002), in a multivariate analysis as compared with those receiving ASCT during the control period. Outcomes for ICU transfer, deconditioning on discharge, time to platelet engraftment, and unplanned 30-day hospital readmission did not differ significantly between groups. CONCLUSION A malnutrition-driven nutritional support protocol may improve outcomes for ASCT patients.
Collapse
Affiliation(s)
- Heather Lazarow
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Ryan Singer
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Cheryl Gilmar
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, PA, USA
| | - Colleen R Kucharczuk
- Department of Advanced Practice, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Mangan
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Salam
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen Cunningham
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward A Stadtmauer
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Landsburg
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
|
34
|
Zama D, Muratore E, Biagi E, Forchielli ML, Rondelli R, Candela M, Prete A, Pession A, Masetti R. Enteral nutrition protects children undergoing allogeneic hematopoietic stem cell transplantation from blood stream infections. Nutr J 2020; 19:29. [PMID: 32276595 PMCID: PMC7149876 DOI: 10.1186/s12937-020-00537-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/27/2020] [Indexed: 12/18/2022] Open
Abstract
Enteral Nutrition (EN) is recommended as first line nutritional support for patients undergoing Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT), but only few studies exist in the literature which compare EN to Parenteral Nutrition (PN) in the paediatric population. Forty-two consecutive paediatric patients undergoing allo-HSCT at our referral centre between January 2016 and July 2019 were evaluated. Post-transplant and nutritional outcomes of patients receiving EN for more than 7 days (EN group, n = 14) were compared with those of patients receiving EN for fewer than 7 days or receiving only PN (PN group, n = 28). In the EN group, a reduced incidence of Blood Stream Infections (BSI) was observed (p = 0.02) (n = 2 vs. n = 15; 14.3% vs. 53.6%). The type of nutritional support was also the only variable independently associated with BSI in the multivariate analysis (p = 0.03). Platelet engraftment was shorter in the PN group than in the EN group for a threshold of > 20*109/L (p = 0.04) (23.1 vs 35.7 days), but this correlation was not confirmed with a threshold of > 50*109/L. The Body Mass Index (BMI) and the BMI Z-score were no different in the two groups from admission to discharge. Our results highlight that EN is a feasible and nutritionally adequate method of nutritional support for children undergoing allo-HSCT in line with the present literature. Future functional studies are needed to better address the hypothesis that greater intestinal eubyosis maintained with EN may explain the observed reduction in BSI.
Collapse
Affiliation(s)
- Daniele Zama
- Paediatric Oncology and Haematology Unit 'Lalla Seràgnoli', Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti, 11, 40138, Bologna, Italy.
| | - Edoardo Muratore
- Paediatric Oncology and Haematology Unit 'Lalla Seràgnoli', Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti, 11, 40138, Bologna, Italy
| | - Elena Biagi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | | | - Roberto Rondelli
- Paediatric Oncology and Haematology Unit 'Lalla Seràgnoli', Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti, 11, 40138, Bologna, Italy
| | - Marco Candela
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Arcangelo Prete
- Paediatric Oncology and Haematology Unit 'Lalla Seràgnoli', Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti, 11, 40138, Bologna, Italy
| | - Andrea Pession
- Paediatric Oncology and Haematology Unit 'Lalla Seràgnoli', Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti, 11, 40138, Bologna, Italy
| | - Riccardo Masetti
- Paediatric Oncology and Haematology Unit 'Lalla Seràgnoli', Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti, 11, 40138, Bologna, Italy
| |
Collapse
|
|
35
|
Changes in body weight and serum liver tests associated with parenteral nutrition compared with no parenteral nutrition in patients with acute myeloid leukemia during remission induction treatment. Support Care Cancer 2020; 28:4381-4393. [DOI: 10.1007/s00520-019-05251-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
|
|
36
|
Febrile Neutropenia in Acute Leukemia. Epidemiology, Etiology, Pathophysiology and Treatment. Mediterr J Hematol Infect Dis 2020; 12:e2020009. [PMID: 31934319 PMCID: PMC6951355 DOI: 10.4084/mjhid.2020.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022] Open
Abstract
Acute leukemias are a group of aggressive malignant diseases associated with a high degree of morbidity and mortality. An important cause of both the latter is infectious complications. Patients with acute leukemia are highly susceptible to infectious diseases due to factors related to the disease itself, factors attributed to treatment, and specific individual risk factors in each patient. Patients with chemotherapy-induced neutropenia are at particularly high risk, and microbiological agents include viral, bacterial, and fungal agents. The etiology is often unknown in infectious complications, although adequate patient evaluation and sampling have diagnostic, prognostic and treatment-related consequences. Bacterial infections include a wide range of potential microbes, both Gram-negative and Gram-positive species, while fungal infections include both mold and yeast. A recurring problem is increasing resistance to antimicrobial agents, and in particular, this applies to extended-spectrum beta-lactamase resistance (ESBL), Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and even carbapenemase-producing Enterobacteriaceae (CPE). International guidelines for the treatment of sepsis in leukemia patients include the use of broad-spectrum Pseudomonas-acting antibiotics. However, one should implant the knowledge of local microbiological epidemiology and resistance conditions in treatment decisions. In this review, we discuss infectious diseases in acute leukemia with a major focus on febrile neutropenia and sepsis, and we problematize the diagnostic, prognostic, and therapeutic aspects of infectious complications in this patient group. Meticulously and thorough clinical and radiological examination combined with adequate microbiology samples are cornerstones of the examination. Diagnostic and prognostic evaluation includes patient review according to the multinational association for supportive care in cancer (MASCC) and sequential organ failure assessment (SOFA) scoring system. Antimicrobial treatments for important etiological agents are presented. The main challenge for reducing the spread of resistant microbes is to avoid unnecessary antibiotic treatment, but without giving to narrow treatment to the febrile neutropenic patient that reduce the prognosis.
Collapse
|
|
37
|
Skaarud KJ, Veierød MB, Lergenmuller S, Bye A, Iversen PO, Tjønnfjord GE. Body weight, body composition and survival after 1 year: follow-up of a nutritional intervention trial in allo-HSCT recipients. Bone Marrow Transplant 2019; 54:2102-2109. [PMID: 31455897 PMCID: PMC6957463 DOI: 10.1038/s41409-019-0638-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/02/2019] [Accepted: 07/21/2019] [Indexed: 12/17/2022]
Abstract
The role of body weight change in survival among recipients of hematopoietic stem-cell transplantation is controversial. We assessed the effect of optimizing energy and protein intake on 1-year survival, body weight and body composition, and the effect of body weight and body composition on 1-year survival in 117 patients (57 intervention, 60 control) in a randomized controlled trial. Cox regression was used to study effects of the intervention, weight and body composition on death, relapse, and nonrelapse mortality (NRM). We found no significant effect of intervention versus control on death hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.54-2.04, p = 0.88), relapse (HR 1.15, 95% CI 0.48-2.27, p = 0.75), and NRM (HR 0.95, 95% CI 0.39-2.28, p = 0.90). Body weight, fat-free mass index, body fat mass index and total body water changed over time (p < 0.001), similarly in both groups (0.17 ≤ p ≤ 0.98). In multivariable analyses adjusted for group, gender and age, HRs and 95% CIs per one kilo increase in weight were 1.03 (1.01-1.06) and 1.04 (1.01-1.08) for death and NRM after 1 year (p ≤ 0.02), respectively, and 1.08 (1.01-1.15) for relapse after 3 months (p = 0.02). In conclusion, weight gain is possibly due to fluid retention and is an indicator of a complication in HSCT, rather than a marker of improved nutritional status.
Collapse
Affiliation(s)
- K J Skaarud
- Department of Haematology, Oslo University Hospital, Oslo, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - M B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - S Lergenmuller
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - A Bye
- European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - P O Iversen
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - G E Tjønnfjord
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Centre for B-Cell Malignancies, University of Oslo, Oslo, Norway
| |
Collapse
|
|
38
|
Lazarow H, Nicolo M, Compher C, Kucharczuk CR, Stadtmauer EA, Landsburg DJ. Nutrition-Related Outcomes for Autologous Stem Cell Transplantation Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e393-e398. [PMID: 31053549 DOI: 10.1016/j.clml.2019.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Autologous stem cell transplantation (ASCT) patients are at risk for malnutrition before transplantation admission as well as malnutrition acquired during their transplantation admission. PATIENTS AND METHODS In this retrospective, observational study we examined data related to consecutive adults (n = 330) admitted for ASCT between 2014 and 2016 at the Hospital of the University of Pennsylvania. Malnutrition risk on admission (identified by the Malnutrition Screening Tool) and transplantation-associated weight loss were analyzed for independent associations with hospital length of stay, nosocomial infection, intensive care unit transfer, deconditioning, time to platelet and neutrophil engraftment, 30-day readmission, and 1-year mortality. RESULTS Adults with high malnutrition risk (n = 60) had a longer median hospital stay (P = .004), longer median time to platelet engraftment (P = .022), increased nosocomial infections (P = .047), and increased 1-year mortality (P = .036). Adults with high transplantation-associated weight loss (n = 100) experienced longer hospital stays (P < .001) and more intensive care unit transfers (P = .001). Outcomes for deconditioning, time to neutrophil engraftment, and 30-day readmission did not differ significantly on the basis of nutrition risk or weight loss. CONCLUSION Further research is needed to determine whether early nutrition intervention would improve these outcomes.
Collapse
Affiliation(s)
- Heather Lazarow
- Hospital of the University of Pennsylvania, Philadelphia, PA.
| | | | | | | | - Edward A Stadtmauer
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
|
39
|
Doney K, McMillen K, Buono L, Deeg HJ, Gooley T. Impact of Body Mass Index on Outcomes of Hematopoietic Stem Cell Transplantation in Adults. Biol Blood Marrow Transplant 2018; 25:613-620. [PMID: 30315943 DOI: 10.1016/j.bbmt.2018.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023]
Abstract
This retrospective analysis of 2503 adult (age ≥20 years) allogeneic hematopoietic cell transplantation (HCT) recipients assessed the effect of body mass index (BMI) on transplantation outcomes. The median patient age was 51.7years. Patients with both nonmalignant and malignant diagnoses were included. Patients received either a myeloablative (52%) or a reduced-intensity (48%) conditioning regimen. Donors were either related (42%) or unrelated (58%). Cord blood recipients were excluded. Granulocyte colony-stimulating factor-mobilized peripheral blood cells were the stem cell source in 86% of transplantations. Graft-versus-host disease prophylaxis included at least 2 immunosuppressive agents, 1 of which was a calcineurin inhibitor. Patient groups were categorized as underweight, normal weight, overweight, obese, or very obese based on BMI. Endpoints included day +100 mortality, overall mortality, nonrelapse mortality (NRM), and relapse. Changes in nutritional status, based on laboratory parameters, were also examined. Underweight patients had significantly lower early and overall survival and greater NRM. Very obese patients had increased NRM, which was associated with the intensity of conditioning regimen. With long-term follow-up, increasing NRM was associated with both underweight and obese patients compared with normal-weight individuals. Changes in serum protein and albumin levels did not correlate with BMI. Although enteral nutrition is now recommended for some undernourished patients, the efficacy of enteral or parenteral nutrition has not been well studied. For obese patients, there are no guidelines regarding weight loss before transplantation, and acute weight loss in the pretransplantation period may be detrimental.
Collapse
Affiliation(s)
- Kristine Doney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington Medical Center, Seattle, Washington.
| | | | - Laura Buono
- Seattle Cancer Care Alliance, Seattle, Washington
| | - H Joachim Deeg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington Medical Center, Seattle, Washington
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington Medical Center, Seattle, Washington
| |
Collapse
|
|
40
|
Tay J, Daly A, Jamani K, Labelle L, Savoie L, Stewart D, Storek J, Beattie S. Patient eligibility for hematopoietic stem cell transplantation: a review of patient-associated variables. Bone Marrow Transplant 2018; 54:368-382. [PMID: 29988063 DOI: 10.1038/s41409-018-0265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/30/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023]
Abstract
Assessing patient eligibility for hematopoietic stem cell transplantation (HSCT) remains a complex, multifaceted challenge. Among these challenges, the paucity of comprehensive clinical data to guide decision making remains problematic coupled with unclear trade-offs between patient, disease and local HSCT center factors. Moreover, it is unclear that the modification of poor patient characteristics will improve post-HSCT outcomes. However, the use of Comorbidity Indices and Comprehensive Geriatric Assessments helps meet this challenge, but may be limited by overlapping patient characteristics. The increasing consideration for pre-HSCT psychosocial assessments and interventions remains to be studied. Ultimately, the decision to proceed with a HSCT remains interdisciplinary while considering the available evidence discussed in this review.
Collapse
Affiliation(s)
- J Tay
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
| | - A Daly
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - K Jamani
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Labelle
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Savoie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - D Stewart
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - J Storek
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - S Beattie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
|
41
|
Ren G, Cai W, Wang L, Huang J, Yi S, Lu L, Wang J. Impact of body mass index at different transplantation stages on postoperative outcomes in patients with hematological malignancies: a meta-analysis. Bone Marrow Transplant 2018; 53:708-721. [DOI: 10.1038/s41409-018-0234-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
|
|
42
|
Baumgartner A, Hoskin K, Schuetz P. Optimization of nutrition during allogeneic hematologic stem cell transplantation. Curr Opin Clin Nutr Metab Care 2018; 21:152-158. [PMID: 29465425 DOI: 10.1097/mco.0000000000000461] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Malnutrition before and during hematopoietic stem cell transplantation (HSCT) is an independent risk factor for mortality in patients undergoing hematopoietic stem cell transplantation. Yet, optimal use of nutritional support to improve outcomes remains controversial. Our aim was to do an up-to-date literature review regarding nutritional therapy in allogeneic HSCT, the neutropenic diet and the use of immunonutrients. RECENT FINDINGS Several observational studies find malnutrition to be associated with poor outcome, increased complications and lower overall survival. There are, however, few interventional trials proving the benefits of nutritional therapy in this population compared with no nutritional treatment. Regarding routes of treatment, studies suggested that parenteral nutrition is associated with higher risk for complications compared with enteral nutrition. Whether the use of specific formulas, such as immunonutrition, has a beneficial effect on clinical outcome is not established yet. Strict use of neutropenic diets did not show a reduction in infection risk and clinical outcome, and can no longer be recommended. SUMMARY Our updated search confirms that malnutrition is a strong negative predictor for outcome, yet optimal use of nutritional interventions to prevent or treat malnutrition remains ill-defined. There is need for larger randomized trials to better address these issues in the future.
Collapse
|
|
43
|
Changes in body composition in children with acute graft-versus-host disease within the first 100 days after hematopoietic stem cell transplantation. Eur J Clin Nutr 2017; 72:1167-1175. [DOI: 10.1038/s41430-017-0057-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 12/14/2022]
|
|
44
|
Glick NR, Fischer MH. Potential Benefits of Ameliorating Metabolic and Nutritional Abnormalities in People With Profound Developmental Disabilities. Nutr Metab Insights 2017; 10:1178638817716457. [PMID: 35185339 PMCID: PMC8855413 DOI: 10.1177/1178638817716457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/21/2017] [Indexed: 11/20/2022] Open
Abstract
Background: People with profound developmental disabilities have some of the most severe neurological impairments seen in society, have accelerated mortality due to huge medical challenges, and yet are often excluded from scientific studies. They actually have at least 2 layers of conditions: (1) the original disability and (2) multiple under-recognized and underexplored metabolic and nutritional imbalances involving minerals (calcium, zinc, and selenium), amino acids (taurine, tryptophan), fatty acids (linoleic acid, docosahexaenoic acid, arachidonic acid, adrenic acid, Mead acid, plasmalogens), carnitine, hormones (insulinlike growth factor 1), measures of oxidative stress, and likely other substances and systems. Summary: This review provides the first list of metabolic and nutritional abnormalities commonly found in people with profound developmental disabilities and, based on the quality of life effects of similar abnormalities in neurotypical people, indicates the potential effects of these abnormalities in this population which often cannot communicate symptoms. Key messages: We propose that improved understanding and management of these disturbed mechanisms would enhance the quality of life of people with profound developmental disabilities. Such insights may also apply to people with other conditions associated with disability, including some diseases requiring stem cell implantation and living in microgravity.
Collapse
Affiliation(s)
- Norris R Glick
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Milton H Fischer
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
|
45
|
Revisiting nutritional support for allogeneic hematologic stem cell transplantation-a systematic review. Bone Marrow Transplant 2017; 52:506-513. [PMID: 28067888 DOI: 10.1038/bmt.2016.310] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
Abstract
In 2009, the American Society of Parenteral and Enteral Nutrition and its European counterpart (Euopean Society for Parenteral and Enteral Nutrition) published guidelines regarding nutritional support of patients with hematologic stem cell transplantation. Our aim was to do an up-to-date literature review regarding benefit of nutritional interventions and treatment recommendations. We searched MEDLINE, EMBASE and Cochrane Library for interventional and observational clinical studies. We extracted data based on a predefined case report form and assessed bias. Out of 459 potential abstracts, 13 studies of mostly moderate quality with a total of 18 167 patients were included. Two very large trials reported negative associations of malnutrition and survival, transplant-related mortality and relapse risk. Some trials found enteral nutrition (EN) to be as effective as parenteral nutrition (PN) with lower complication rates. In addition, EN was associated with better survival, less acute GvHD and faster neutrophil recovery. A neutropenic diet was not superior regarding overall survival, but in contrast resulted in higher infection risk. Current moderate quality studies show negative associations of malnutrition and clinical outcomes, with EN being superior to PN. There was no benefit of neutropenic diets. Large, randomized controlled studies are needed to better understand optimal nutritional support in this patient population.
Collapse
|