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Impact of route and adequacy of nutritional intake on outcomes of allogeneic haematopoietic cell transplantation for haematologic malignancies

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Title: Impact of route and adequacy of nutritional intake on outcomes of allogeneic haematopoietic cell transplantation for haematologic malignancies
Authors: Beckerson, J
Szydlo, RM
Hickson, M
Mactier, CE
Innes, AJ
Gabriel, IH
Palanicawandar, R
Kanfer, EJ
Macdonald, DH
Milojkovic, D
Rahemtulla, A
Chaidos, A
Karadimitris, A
Olavarria, E
Apperley, JF
Pavlu, J
Item Type: Journal Article
Abstract: BACKGROUND: Allogeneic haematopoietic cell transplantation (HCT) is often associated with poor oral intake due to painful mucositis and gastrointestinal sequalae that occur following a preparative regimen of intensive chemotherapy and/or total body radiation. Although attractive to assume that optimal nutrition improves HCT outcomes, there are limited data to support this. It is also unclear whether artificial nutrition support should be provided as enteral tube feeding or parenteral nutrition (PN). METHODS: We analysed day-100 non-relapse mortality (NRM), incidence of acute graft-versus-host disease (GvHD), acute gastrointestinal GvHD, 5-year survival and GvHD-free/relapse-free survival (GRFS) according to both route and adequacy of nutritional intake prior to neutrophil engraftment, together with other known prognostic factors, in a retrospective cohort of 484 patients who underwent allogeneic HCT for haematologic malignancy between 2000 and 2014. RESULTS: Multivariate analyses showed increased NRM with inadequate nutrition (hazard ratio (HR) 4.1; 95% confidence interval (CI) 2.2-7.2) and adequate PN (HR 2.9; 95% CI 1.6-5.4) compared to adequate enteral nutrition (EN) both P < .001. There were increased incidences of gastrointestinal GvHD of any stage and all GvHD ≥ grade 2 in patients who received PN (odds ratio (OR) 2.0; 95% CI 1.2-3.3; P = .006, and OR 1.8; 95% CI 1.1-3.0; P = .018, respectively), compared to adequate EN. Patients who received adequate PN and inadequate nutrition also had reduced probabilities of survival and GRFS at 5 years. CONCLUSION: Adequate EN during the early transplantation course is associated with reduced NRM, improved survival and GRFS at 5 years. Furthermore, adequate EN is associated with lower incidence of overall and gut acute GvHD than PN, perhaps because of its ability to maintain mucosal integrity, modulate the immune response to intensive chemo/radiotherapy and support the gastrointestinal tract environment, including gut microflora.
Issue Date: 1-Apr-2019
Date of Acceptance: 11-Mar-2018
URI: http://hdl.handle.net/10044/1/58590
DOI: https://dx.doi.org/10.1016/j.clnu.2018.03.008
ISSN: 0261-5614
Publisher: Elsevier
Start Page: 738
End Page: 744
Journal / Book Title: Clinical Nutrition
Volume: 38
Issue: 2
Copyright Statement: © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
National Institute for Health Research
Funder's Grant Number: RDB01
RDB01
NF-SI-0611-10275
Keywords: Science & Technology
Life Sciences & Biomedicine
Nutrition & Dietetics
Allogeneic stem cell transplant
Survival
Graft-versus-host-disease
Enteral nutrition
Parenteral nutrition
Non-relapse mortality
Haematologic malignancy
Artificial nutrition support
TOTAL PARENTERAL-NUTRITION
VERSUS-HOST-DISEASE
INTESTINAL MICROBIOTA
GUT MICROBIOME
SUPPORT
CARE
HOME
Allogeneic stem cell transplant
Artificial nutrition support
Enteral nutrition
Graft-versus-host-disease
Haematologic malignancy
Non-relapse mortality
Parenteral nutrition
Survival
Allogeneic stem cell transplant
Artificial nutrition support
Enteral nutrition
Graft-versus-host-disease
Haematologic malignancy
Non-relapse mortality
Parenteral nutrition
Survival
1111 Nutrition and Dietetics
Nutrition & Dietetics
Publication Status: Published
Conference Place: England
Online Publication Date: 2018-03-28
Appears in Collections:Department of Medicine
Faculty of Medicine



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