Role of Nutrition Support in Improving Outcomes in Allogeneic Stem Cell Transplant Patients

Abstract

Introduction: Allogeneic hematopoietic stem cell transplant (Allo-SCT) can be associated with several complications related to the cytotoxic conditioning regimen, infections associated with immune suppression, and GVHD. Malnutrition amongst Allo-SCT patients has been reported to be an independent negative prognostic factor. It may be evident on presentation or develop as a sequela of decreased appetite, mucositis, and digestive GVHD. Whether supportive nutrition (enteral feeding or total parenteral nutrition (TPN)) contributes to favorable transplant outcomes is yet to be determined. Methods: We conducted a retrospective single-center study that evaluated patients who underwent Allo-SCT from Jan 2018 through Sept 2021. A chart review was conducted, and relevant data was collected. Primary outcomes were the impact of nutrition support (enteral feeding, TPN or both) among malnourished patients during the first 100 days post-transplant (T+100) on mortality and the composite outcome of acute GVHD incidence, infection rate, and days to engraftment. A higher composite score indicated worse outcomes. GVHD grading was based on the CIBMTR grading system (I-IV). The data was analyzed using Chi-Square and two-sample t-test. Results: A total of 70 Allo-SCT patients were identified. Of them, 42 (60%) were diagnosed with malnutrition, of which 23 (55%) received nutrition support. The mortality rate in patients who required nutrition support was significantly higher compared to those who did not receive nutrition support (83% (19/23) vs 11% (2/19)) with an odds ratio of 40 for this association (CI 6.5-248.9, p-value < 0.0001). The composite outcome was statistically higher amongst patients requiring nutrition support (mean 2.0, median score 1.8, SD 0.6) compared to those who did not need nutritional support (mean 1.6, median score 1.5, SD 0.4). These differences were found to be statistically significant using the Satterthwaite method (p-value 0.0218). Conclusion: Based on this data, we found that a reactive approach of nutrition support in the setting of malnutrition had no benefit on mortality and our pre-defined composite outcome during the first 100 days of allogeneic stem cell transplantation. This is fuel for conducting a prospective study using a preemptive enteral feeding approach to prevent the development of malnutrition and related complications.