Nutritional Assessment As Predictor of Complications Post Hematopoietic Cell Transplantation

INTRODUCTION: Nutritional support is pivotal in patients with hematologic malignancies and hematopoietic cell transplantation (HCT). Optimal nutritional status is associated with a shorter time of engraftment and less infection rates during the initial phase. We present our experience in nutritional assessment pre and post transplantation.

OBJECTIVE: To evaluate the possible association between nutritional parameters and outcomes such as overall survival and specific complications, in patients who underwent HCT.

PATIENTS AND METHODS: Retrospective study in patients with HCT between June 2011 and May 2014 in our center. We assessed nutritional status before transplantation and then 10 days after it. Nutritional assessment included anthropometry, body mass index (BMI), albumin, prealbumin and total urinary nitrogen (TUN). Statistical analysis was made using IBP SSPS v.20. 

RESULTS: We studied a total of 50 patients between June 2011 and May 2014. Media following time: 35 months. Median age was 41 years (18-67), 33 (66%) were male and 17 (33%) female. Thirty two underwent (64%) allogeneic HCT and 18 (36%) autologous HSCT, with 42 undergoing (84%) myeloablative conditioning and 8 (16%) reduced intensity conditioning. Diagnoses included acute leukemia (26), lymphoma (7), multiple myeloma (13), and aplastic anemia (3).  Thirty seven patients developed mucositis and 31 required parenteral nutrition (PN). Twenty three patients developed mucositis and required PN (mild: 2, moderate: 20, severe: 1) Incidence of mucositis between allogeneic and autologous HCT that required PN was similar (75% vs 72%). Albumin levels were 4,1mg/dL before and 3,3 mg/dL 10 days after HSCT (p< 0,05). No difference was found between BMI, dynamometry and TUN before and after HCT. TUN before HCT was associated with more days of PN (p<0,05). Multivariate analysis showed an association between lower albumin levels after HCT and PN requirement, as well as a longer length of stay. High TUN and lower albumin levels after HCT were associated with longer platelet engraftment time (p<0,05). Longer engrafment time was associated with longer duration of PN (p<0,05). Nine patients (28%) in the allogeneic group developed acute gastrointestinal graft versus host disease (GVHD) that required prolonged PN. No association was found between BMI, albumin, prealbumin, TUN or requirement of PN, with the risk of mucositis or infectious complications. None of the evaluated nutritional parameters were associated with overall survive (OS).

CONCLUSION: High catabolism was associated with a longer length of stay, the requirement of PN and a prolonged platelet engraftment time. Acute gastrointestinal GVHD was associated with more requirement and a longer duration of PN. Nutritional parameters were not associated with any risk of infection and OS.