Enteral versus parenteral nutritional support in allogeneic haematopoietic stem-cell transplantation

Abstract

Allogeneic haematopoietic stem-cell transplantation (allo-HSCT) is associated with frequent and severe malnutrition, which may contribute to transplant-related morbidity. While both enteral nutrition (EN) via a nasogastric tube and parenteral nutrition (PN) are effective, it remains unclear what is the optimal method of nutritional support. We propose to compare the impact of EN versus PN on early outcome after allo-HSCT. We evaluated the effect of initial nutritional support with EN versus PN on early outcome in 56 patients who required nutritional support after first allo-HSCT for haematological malignancies in our centre. Patients were offered EN but could decline and chose to be treated by PN. Twenty patients received myeloablative conditioning and 36 received reduced-intensity conditioning. Twenty-eight patients received EN and 28 received PN. Compared with PN, EN was associated with a lower median duration of fever (2 versus 5 days; p < 0.01), a reduced need for empirical antifungal therapy (7 versus 17 patients; p < 0.01), a lower rate of central venous catheter replacement (9 versus 3 patients; p = 0.051) and a lower rate of transfer to intensive care (2 versus 8 patients; p = 0.036). The early death rate (<100 days) was the same in both groups (14%). Compared with PN, EN was associated with a lower risk of infection in allo-HSCT, without an increase in the incidence of graft-versus-host disease.