Nutritional management in patients subjected to hematopoietic stem cell transplantation

Abstract

Hematopoietic stem cell transplantation (HSCT) – the highly aggressive therapeutic process – is connected with high risk of side effects and complications, which influence nutritional management.

Moreover, limitation of possibility of nutrients delivery is accompanied by simultaneous increase in requirement for nutritional elements. Thus, implementation of nutritional support as an element of supportive treatment is advisable or necessary in many of these patients.

Unfortunately, there is a lack of uniform clinical nutrition guidelines for HSCT patients. Currently, special attention is paid to: suitable qualification for different form of nutritional support, consideration of routine implementation of nutritional support after myeloablative conditioning (especially with total body irradiation), avoidance of unjustified arrest of oral/enteral nutrition (probably higher risk of Graft-vs-Host disease – GvHD) and likely clinical advantages of the use of glutamine and/or omega-3 fatty acids in nutritional mixtures.

Moreover, in the context of clinical nutrition, patients with severe gastro-intestinal toxicity and persons with GvHD grade>II with intestinal failure require special attention. For these patients, primary nutritional support is parenteral nutrition (PN).

The indications of PN implementation include: impossible, ineffective (e.g. nutrients absorption <50% daily requirements) or contraindicated oral/enteral feeding and progressive undernutrition. In case of use of myeloablative conditioning with total body irradiation and high-dose chemotherapy, the routine PN initiation should be taken into consideration according to preemptive strategy.

Composition of intravenous nutritional mixtures is also very important. Based on scientific references and own study, the addition of glutamine and omega-3 fatty acids seems to be advisable (e.g. positive influence of mucous membrane regeneration and hematopoietic recovery, less complications). However, not all clinical studies confirmed above mentioned advantages. Moreover, optimal daily dose of these substrates is currently unknown.