Abstract
Malnutrition is a common problem after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and could impair immune function. Immune dysfunction after allo-HSCT may be linked with infections, GVHD, and relapse and negatively affect the outcome. Aim of this review was to identify malnutrition biomarkers, potentially useful for immune-system monitoring, in the setting of allo-HSCT. After a systematic search, no satisfying biomarker was found, except for citrulline. Citrulline could be useful in monitoring gastrointestinal function after allo-HSCT and its role in the complex relationship with immune-system function ought to be better explored. A multi-omics approach, including biomarkers and PRO (patient reported outcomes) is, in our opinion, the optimal way to study the relationship between malnutrition and transplant outcomes.
Highlights
Malnutrition is common in patients suffering from cancer since 20 to 70% of them experience undernutrition and about 10 to 20% of the deaths are related to malnutrition [1].In hematologic patients, malnutrition frequently develops during treatment, in the case of patients receiving chemo-radiotherapy [2] regimens for allogeneic hematopoietic stem cell transplantation [3].As is known, in the allo-HSCT a chemo-radiotherapy conditioning regimen is followed by healthy donor hematopoietic stem cells (HSCs) infusion and immune-suppression to control graft rejection and graft versus host disease (GVHD).Before allo-HSCT, most patients present a good nutritional status, defined according to SGA (Subjective Global Assessment) and only 23% of them are malnourished [4]
The analysis identified lower albumin and pre-albumin and higher triglycerides as potential useful biomarkers for nutritional related outcomes: despite these findings, BMI was not affected in allo-HSCT setting
The nutritional status in patients subjected to alloHSCT should be assessed by combining anthropometric data (e.g. DEXA, BIA, direct or indirect calorimetry), biochemical markers, and questionnaires collecting patients’ reported outcome (PRO), such as the Patient-Oriented Subjective Global Assessment (PGSGA score), or dietary intake
Summary
Malnutrition is common in patients suffering from cancer since 20 to 70% of them experience undernutrition and about 10 to 20% of the deaths are related to malnutrition [1].In hematologic patients, malnutrition frequently develops during treatment, in the case of patients receiving chemo-radiotherapy [2] regimens for allogeneic hematopoietic stem cell transplantation (allo-HSCT) [3].As is known, in the allo-HSCT a chemo-radiotherapy conditioning regimen is followed by healthy donor hematopoietic stem cells (HSCs) infusion and immune-suppression to control graft rejection and graft versus host disease (GVHD).Before allo-HSCT, most patients present a good nutritional status, defined according to SGA (Subjective Global Assessment) and only 23% of them are malnourished [4]. Malnutrition frequently develops during treatment, in the case of patients receiving chemo-radiotherapy [2] regimens for allogeneic hematopoietic stem cell transplantation (allo-HSCT) [3]. In the allo-HSCT a chemo-radiotherapy conditioning regimen is followed by healthy donor hematopoietic stem cells (HSCs) infusion and immune-suppression to control graft rejection and graft versus host disease (GVHD). Considering the indirect effects that the nutritional status may have on transplant-related outcomes, improving the patient’s nutritional status may reduce the incidence of infections and acute or chronic graft versus host disease (GVHD), may improve hematological and immunological recovery and, may increase the long-term overall survival by reducing the nonrelapse mortality (NRM) [1, 7,8,9]
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