Skip to main content
SpringerLink
Log in

Nutritional Support in Adult Patients Undergoing Allogeneic Stem Cell Transplantation Following Myeloablative Conditioning

  • Living reference work entry
  • First Online:
Diet and Nutrition in Critical Care

  • 138 Accesses

Abstract

Allogeneic stem cell transplantation (allo-SCT) and its consequences are a perfect illustration of the different pathophysiological pathways leading to protein–energy malnutrition, which is characterized by a decrease in oral intake, an increase in metabolic needs, and the appearance of digestive losses. Malnutrition is a crucial target because of its consequences for morbidity and mortality in recipients. Thus, nutritional assessment, counseling, and intervention should be incorporated systematically into the care of each patient. Posttransplantation support includes monitoring of nutritional status and metabolic disorders, prevention of micronutrient deficiencies, promotion of low-microbial oral feeding, and rational use of both enteral nutrition (EN) and parenteral nutrition (PN). Rather than being opposing strategies, EN and PN are complementary in the care of disease-related malnutrition. EN appears useful for limiting gut atrophy and bacterial translocation, which promote sepsis and acute graft-versus-host disease, whereas PN becomes a rescue option when oral or enteral intake is insufficient or impossible. However, PN cannot substitute for the effect of EN on gut trophicity. Future research on nutritional support for allo-SCT patients should focus on this complementarity and should define more precisely the place of immunonutrients, such as glutamine, according to the type of transplant.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Abbreviations

allo-SCT:

Allogeneic stem cell transplantation

APC:

Antigen-presenting cells

BMI:

Body mass index

EN:

Enteral nutrition

GVHD:

Graft-versus-host disease

IFN-γ:

Interferon gamma

IL-1:

Interleukin 1

MAC allo-SCT:

Allogeneic stem cell transplantation following myeloablative conditioning

PN:

Parenteral nutrition

TNF-α:

Tumor necrosis factor alpha

References

  • Alpers DH. Enteral feeding and gut atrophy. Curr Opin Clin Nutr Metab Care. 2002;5:679–83.

    Article  CAS  PubMed  Google Scholar 

  • Anderson PM, Ramsay NK, Shu XO, et al. Effect of low-dose oral glutamine on painful stomatitis during bone marrow transplantation. Bone Marrow Transplant. 1998;22:339–44.

    Article  CAS  PubMed  Google Scholar 

  • Aquino VM, Harvey AR, Garvin JH, et al. A double-blind randomized placebo-controlled study of oral glutamine in the prevention of mucositis in children undergoing hematopoietic stem cell transplantation: a pediatric blood and marrow transplant consortium study. Bone Marrow Transplant. 2005;36:611–6.

    Article  CAS  PubMed  Google Scholar 

  • Arends J, Bodoky G, Bozzetti F, et al. ESPEN guidelines on enteral nutrition: non-surgical oncology. Clin Nutr. 2006;25:245–59.

    Article  CAS  PubMed  Google Scholar 

  • August DA, Huhmann MB. A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr. 2009;33:472–500.

    Article  PubMed  Google Scholar 

  • Azarnoush S, Bruno B, Beghin L, et al. Enteral nutrition: a first option for nutritional support of children following allo-SCT? Bone Marrow Transplant. 2012;47:1191–5.

    Article  CAS  PubMed  Google Scholar 

  • Blijlevens NM, Donnelly JP, De Pauw BE. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant. 2000;25:1269–78.

    Article  CAS  PubMed  Google Scholar 

  • Bozzetti F, Arends J, Lundholm K, et al. ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clin Nutr. 2009;28:445–54.

    Article  CAS  PubMed  Google Scholar 

  • Buchman AL, Moukarzel AA, Bhuta S, et al. Parenteral nutrition is associated with intestinal morphologic and functional changes in humans. JPEN J Parenter Enteral Nutr. 1995;19:453–60.

    Article  CAS  PubMed  Google Scholar 

  • Cahn JY, Klein JP, Lee SJ, et al. Prospective evaluation of 2 acute graft-versus-host (GVHD) grading systems: a joint Societe Francaise de Greffe de Moelle et Therapie Cellulaire (SFGM-TC), Dana Farber Cancer Institute (DFCI), and International Bone Marrow Transplant Registry (IBMTR) prospective study. Blood. 2005;106:1495–500.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Carlin A, Walker WA. Rapid development of vitamin K deficiency in an adolescent boy receiving total parenteral nutrition following bone marrow transplantation. Nutr Rev. 1991;49:179–83.

    Article  CAS  PubMed  Google Scholar 

  • Cetin T, Arpaci F, Dere Y, et al. Total parenteral nutrition delays platelet engraftment in patients who undergo autologous hematopoietic stem cell transplantation. Nutrition. 2002;18:599–603.

    Article  CAS  PubMed  Google Scholar 

  • Crowther M, Avenell A, Culligan DJ. Systematic review and meta-analyses of studies of glutamine supplementation in haematopoietic stem cell transplantation. Bone Marrow Transplant. 2009;44:413–25.

    Article  CAS  PubMed  Google Scholar 

  • Deeg HJ, Seidel K, Bruemmer B, et al. Impact of patient weight on non-relapse mortality after marrow transplantation. Bone Marrow Transplant. 1995;15:461–8.

    CAS  PubMed  Google Scholar 

  • Derikx JP, Blijlevens NM, Donnelly JP, et al. Loss of enterocyte mass is accompanied by diminished turnover of enterocytes after myeloablative therapy in haematopoietic stem-cell transplant recipients. Ann Oncol. 2009;20:337–42.

    Article  CAS  PubMed  Google Scholar 

  • Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.

    Article  CAS  PubMed  Google Scholar 

  • Duncan CN, Vrooman L, Apfelbaum EM, et al. 25-hydroxy vitamin D deficiency following pediatric hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2011;17:749–53.

    Article  CAS  PubMed  Google Scholar 

  • Eagle DA, Gian V, Lauwers GY, et al. Gastroparesis following bone marrow transplantation. Bone Marrow Transplant. 2001;28:59–62.

    Article  CAS  PubMed  Google Scholar 

  • Goldberg J, Jacobsohn DA, Zahurak ML, et al. Gastrointestinal toxicity from the preparative regimen is associated with an increased risk of graft-versus-host disease. Biol Blood Marrow Transplant. 2005;11:101–7.

    Article  PubMed  Google Scholar 

  • Guieze R, Lemal R, Cabrespine A, et al. Enteral versus parenteral nutritional support in allogeneic haematopoietic stem-cell transplantation. Clin Nutr. 2013;33:533–8.

    Google Scholar 

  • Herbers AH, Feuth T, Donnelly JP, et al. Citrulline-based assessment score: first choice for measuring and monitoring intestinal failure after high-dose chemotherapy. Ann Oncol. 2010;21:1706–11.

    Article  CAS  PubMed  Google Scholar 

  • Hernandez G, Velasco N, Wainstein C, et al. Gut mucosal atrophy after a short enteral fasting period in critically ill patients. J Crit Care. 1999;14:73–7.

    Article  CAS  PubMed  Google Scholar 

  • Hill GR, Ferrara JL. The primacy of the gastrointestinal tract as a target organ of acute graft-versus-host disease: rationale for the use of cytokine shields in allogeneic bone marrow transplantation. Blood. 2000;95:2754–9.

    CAS  PubMed  Google Scholar 

  • Hill GR, Crawford JM, Cooke KR, et al. Total body irradiation and acute graft-versus-host disease: the role of gastrointestinal damage and inflammatory cytokines. Blood. 1997;90:3204–13.

    CAS  PubMed  Google Scholar 

  • Hopman GD, Pena EG, Le CS, et al. Tube feeding and bone marrow transplantation. Med Pediatr Oncol. 2003;40:375–9.

    Article  CAS  PubMed  Google Scholar 

  • Iestra JA, Fibbe WE, Zwinderman AH, et al. Parenteral nutrition following intensive cytotoxic therapy: an exploratory study on the need for parenteral nutrition after various treatment approaches for haematological malignancies. Bone Marrow Transplant. 1999;23:933–9.

    Article  CAS  PubMed  Google Scholar 

  • Jacobsohn DA, Vogelsang GB. Acute graft versus host disease. Orphanet J Rare Dis. 2007;2:35.

    Article  PubMed Central  PubMed  Google Scholar 

  • Jaime-Perez JC, Colunga-Pedraza PR, Gutierrez-Gurrola B, et al. Obesity is associated with higher overall survival in patients undergoing an outpatient reduced-intensity conditioning hematopoietic stem cell transplant. Blood Cells Mol Dis. 2013;51:61–5.

    Article  PubMed  Google Scholar 

  • Johansson JE, Ekman T. Gastro-intestinal toxicity related to bone marrow transplantation: disruption of the intestinal barrier precedes clinical findings. Bone Marrow Transplant. 1997;19:921–5.

    Article  CAS  PubMed  Google Scholar 

  • Johansson JE, Ekman T. Gut toxicity during hematopoietic stem cell transplantation may predict acute graft-versus-host disease severity in patients. Dig Dis Sci. 2007;52:2340–5.

    Article  PubMed  Google Scholar 

  • Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr. 2000;72:181–9.

    CAS  PubMed  Google Scholar 

  • June CH, Thompson CB, Kennedy MS, et al. Profound hypomagnesemia and renal magnesium wasting associated with the use of cyclosporine for marrow transplantation. Transplantation. 1985;39:620–4.

    Article  CAS  PubMed  Google Scholar 

  • Keller U, Kraenzlin ME, Gratwohl A, et al. Protein metabolism assessed by 1-13C leucine infusions in patients undergoing bone marrow transplantation. JPEN J Parenter Enteral Nutr. 1990;14:480–4.

    Article  CAS  PubMed  Google Scholar 

  • Kruizenga HM, Wierdsma NJ, van Bokhorst MA, et al. Screening of nutritional status in The Netherlands. Clin Nutr. 2003;22:147–52.

    Article  CAS  PubMed  Google Scholar 

  • Kyle UG, Chalandon Y, Miralbell R, et al. Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients. Bone Marrow Transplant. 2005;35:1171–7.

    Article  CAS  PubMed  Google Scholar 

  • Langdana A, Tully N, Molloy E, et al. Intensive enteral nutrition support in paediatric bone marrow transplantation. Bone Marrow Transplant. 2001;27:741–6.

    Article  CAS  PubMed  Google Scholar 

  • Lipkin AC, Lenssen P, Dickson BJ. Nutrition issues in hematopoietic stem cell transplantation: state of the art. Nutr Clin Pract. 2005;20:423–39.

    Article  PubMed  Google Scholar 

  • Ljungman P, Urbano-Ispizua A, Cavazzana-Calvo M, et al. Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: definitions and current practice in Europe. Bone Marrow Transplant. 2006;37:439–49.

    Article  CAS  PubMed  Google Scholar 

  • Lough M, Watkins R, Campbell M, et al. Parenteral nutrition in bone marrow transplantation. Clin Nutr. 1990;9:97–101.

    Article  CAS  PubMed  Google Scholar 

  • Lutgens LC, Blijlevens NM, Deutz NE, et al. Monitoring myeloablative therapy-induced small bowel toxicity by serum citrulline concentration: a comparison with sugar permeability tests. Cancer. 2005;103:191–9.

    Article  PubMed  Google Scholar 

  • MacDonald KP, Shlomchik WD, Reddy P. Biology of graft-versus-host responses: recent insights. Biol Blood Marrow Transplant. 2013;19:S10–4.

    Article  PubMed Central  PubMed  Google Scholar 

  • MacFie J, Reddy BS, Gatt M, et al. Bacterial translocation studied in 927 patients over 13 years. Br J Surg. 2006;93:87–93.

    Article  CAS  PubMed  Google Scholar 

  • Martin-Salces M, de Paz R, Canales MA, et al. Nutritional recommendations in hematopoietic stem cell transplantation. Nutrition. 2008;24:769–75.

    Article  CAS  PubMed  Google Scholar 

  • Mattsson J, Westin S, Edlund S, et al. Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease. Bone Marrow Transplant. 2006;38:629–33.

    Article  CAS  PubMed  Google Scholar 

  • Murray SM, Pindoria S. Nutrition support for bone marrow transplant patients. Cochrane Database Syst Rev. 2009;(1): CD002920.

    Google Scholar 

  • Muscaritoli M, Grieco G, Capria S, et al. Nutritional and metabolic support in patients undergoing bone marrow transplantation. Am J Clin Nutr. 2002;75:183–90.

    CAS  PubMed  Google Scholar 

  • Papadopoulou A, Lloyd DR, Williams MD, et al. Gastrointestinal and nutritional sequelae of bone marrow transplantation. Arch Dis Child. 1996;75:208–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Papadopoulou A, MacDonald A, Williams MD, et al. Enteral nutrition after bone marrow transplantation. Arch Dis Child. 1997;77:131–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Raynard B, Nitenberg G, Gory-Delabaere G, et al. Summary of the Standards, Options and Recommendations for nutritional support in patients undergoing bone marrow transplantation (2002). Br J Cancer. 2003;89 Suppl 1:S101–6.

    Article  PubMed Central  PubMed  Google Scholar 

  • Ritchie DS, Szer J, Roberts AW, et al. A phase I dose-escalation study of etoposide continuous infusion added to busulphan/cyclophosphamide as conditioning prior to autologous or allogeneic stem cell transplantation. Bone Marrow Transplant. 2002;30:645–50.

    Article  CAS  PubMed  Google Scholar 

  • Russell JA, Kangarloo SB, Williamson T, et al. Establishing a target exposure for once-daily intravenous busulfan given with fludarabine and thymoglobulin before allogeneic transplantation. Biol Blood Marrow Transplant. 2013;19:1381–6.

    Article  CAS  PubMed  Google Scholar 

  • Schulte C, Reinhardt W, Beelen D, et al. Low T3-syndrome and nutritional status as prognostic factors in patients undergoing bone marrow transplantation. Bone Marrow Transplant. 1998;22:1171–8.

    Article  CAS  PubMed  Google Scholar 

  • Sefcick A, Anderton D, Byrne JL, et al. Naso-jejunal feeding in allogeneic bone marrow transplant recipients: results of a pilot study. Bone Marrow Transplant. 2001;28:1135–9.

    Article  CAS  PubMed  Google Scholar 

  • Seguy D, Berthon C, Micol JB, et al. Enteral feeding and early outcomes of patients undergoing allogeneic stem cell transplantation following myeloablative conditioning. Transplantation. 2006;82:835–9.

    Article  PubMed  Google Scholar 

  • Seguy D, Duhamel A, Rejeb MB, et al. Better outcome of patients undergoing enteral tube feeding after myeloablative conditioning for allogeneic stem cell transplantation. Transplantation. 2012;94:287–94.

    Article  CAS  PubMed  Google Scholar 

  • Sheean PM, Braunschweig C, Rich E. The incidence of hyperglycemia in hematopoietic stem cell transplant recipients receiving total parenteral nutrition: a pilot study. J Am Diet Assoc. 2004;104:1352–60.

    Article  PubMed  Google Scholar 

  • Sheean PM, Freels SA, Helton WS, et al. Adverse clinical consequences of hyperglycemia from total parenteral nutrition exposure during hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2006;12:656–64.

    Article  PubMed  Google Scholar 

  • Soga Y, Sugiura Y, Takahashi K, et al. Progress of oral care and reduction of oral mucositis–a pilot study in a hematopoietic stem cell transplantation ward. Support Care Cancer. 2010;19:303–7.

    Article  PubMed  Google Scholar 

  • Sonis ST, Oster G, Fuchs H, et al. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol. 2001;19:2201–5.

    CAS  PubMed  Google Scholar 

  • Svahn BM, Remberger M, Heijbel M, et al. Case–control comparison of at-home and hospital care for allogeneic hematopoietic stem-cell transplantation: the role of oral nutrition. Transplantation. 2008;85:1000–7.

    Article  PubMed  Google Scholar 

  • Szeluga DJ, Stuart RK, Brookmeyer R, et al. Nutritional support of bone marrow transplant recipients: a prospective, randomized clinical trial comparing total parenteral nutrition to an enteral feeding program. Cancer Res. 1987;47:3309–16.

    CAS  PubMed  Google Scholar 

  • Taskinen M, Saarinen UM. Skeletal muscle protein reserve after bone marrow transplantation in children. Bone Marrow Transplant. 1996;18:937–41.

    CAS  PubMed  Google Scholar 

  • van der Meij BS, de Graaf P, Wierdsma NJ, et al. Nutritional support in patients with GVHD of the digestive tract: state of the art. Bone Marrow Transplant. 2013;48:474–82.

    Article  PubMed  Google Scholar 

  • van der Velden WJ, Blijlevens NM, Feuth T, et al. Febrile mucositis in haematopoietic SCT recipients. Bone Marrow Transplant. 2009;43:55–60.

    Article  PubMed  Google Scholar 

  • van der Velden WJ, Herbers AH, Feuth T, et al. Intestinal damage determines the inflammatory response and early complications in patients receiving conditioning for a stem cell transplantation. PLoS One. 2010;5:e15156.

    Article  PubMed Central  PubMed  Google Scholar 

  • Vokurka S, Svoboda T, Rajdl D, et al. Serum citrulline levels as a marker of enterocyte function in patients after allogeneic hematopoietic stem cells transplantation – a pilot study. Med Sci Monit. 2013;19:81–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Weisdorf SA, Lysne J, Wind D, et al. Positive effect of prophylactic total parenteral nutrition on long-term outcome of bone marrow transplantation. Transplantation. 1987;43:833–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. INSERM U995, Faculté de Médecine, Université de Lille, Lille, France

    David Seguy

  2. Service de Nutrition, Hôpital Claude Huriez – CHRU de Lille, Rue Michel Polonovski, 59037 Cedex, Lille, France

    Nicolas Danel Buhl & David Seguy

Authors
  1. Nicolas Danel Buhl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Seguy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Seguy .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this entry

Cite this entry

Buhl, N.D., Seguy, D. (2014). Nutritional Support in Adult Patients Undergoing Allogeneic Stem Cell Transplantation Following Myeloablative Conditioning. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_152-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_152-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Online ISBN: 978-1-4614-8503-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation