Abstract
The role of body weight change in survival among recipients of hematopoietic stem-cell transplantation is controversial. We assessed the effect of optimizing energy and protein intake on 1-year survival, body weight and body composition, and the effect of body weight and body composition on 1-year survival in 117 patients (57 intervention, 60 control) in a randomized controlled trial. Cox regression was used to study effects of the intervention, weight and body composition on death, relapse, and nonrelapse mortality (NRM). We found no significant effect of intervention versus control on death hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.54−2.04, p = 0.88), relapse (HR 1.15, 95% CI 0.48−2.27, p = 0.75), and NRM (HR 0.95, 95% CI 0.39−2.28, p = 0.90). Body weight, fat-free mass index, body fat mass index and total body water changed over time (p < 0.001), similarly in both groups (0.17 ≤ p ≤ 0.98). In multivariable analyses adjusted for group, gender and age, HRs and 95% CIs per one kilo increase in weight were 1.03 (1.01−1.06) and 1.04 (1.01−1.08) for death and NRM after 1 year (p ≤ 0.02), respectively, and 1.08 (1.01−1.15) for relapse after 3 months (p = 0.02). In conclusion, weight gain is possibly due to fluid retention and is an indicator of a complication in HSCT, rather than a marker of improved nutritional status.
Highlights
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.Department of Haematology, Oslo University Hospital, Oslo, NorwayDepartment of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, NorwayOslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, NorwayEuropean Palliative Care Research Centre, Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayK.G
A study found increased risk of nonrelapse mortality (NRM) and inferior overall survival in patients with >10% weight loss compared with weight loss
We assessed the effects of weight, fat-free mass index (FFMI) and body fat mass index (BFMI) at baseline on death, relapse and NRM 1-year post-HSCT with similar results in univariable and multivariable analyses except for BFMI who changed from nonsignificant in the univariable to significant in the multivariable analysis (Supplementary Table S4a), the multivariable p values are reported here
Summary
Several studies have assessed the effect of nutritional interventions on body weight and survival in allo-HSCT recipients. Individually adjusted parenteral nutrition with an electrolyte-enriched solution [11] Both studies reported improved body weight [10, 11], and the former found improved overall survival [10]. The intervention had no effect on the primary endpoint, global quality of life, or the main secondary outcomes, oral mucositis and acute graft-versus-host disease (aGVHD) [15] The aim of this 1-year follow-up was to explore: (i) the effect of the intervention on death, relapse and NRM, (ii) changes in weight and body composition, and (iii) the effect of changes in weight and body composition on death, relapse and NRM
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