[Standards, options and recommendations for nutritional support in bone marrow transplant patients].
BACKGROUND
The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French cancer centers and specialists from French public university and general hospitals and private clinics. Its main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.


OBJECTIVE
To develop, according to the definitions of the Standards, Options and Recommendations, clinical practice guidelines for nutritional support in bone marrow transplant patients.


METHODS
Data were identified by searching Medline , web sites and the personal reference lists of members of the expert groups, then submitted for review to 75 independent reviewers.


RESULTS
The main recommendations for nutritional support in bone marrow transplant patients are: 1) Nutritional evaluation and monitoring may be proposed to bone-marrow transplant recipients (options). 2) Nutritional evaluation consists of body weight assessment and percent weight loss evaluation (standard, expert agreement). 3) Nutritional monitoring should include daily weight monitoring, clinical monitoring of hydration and assessment of daily dietary intake (standard, expert agreement). 4) Artificial nutrition is recommended in immuno-suppressed bone marrow transplant patients. This is not systematically indicated in other situation (standard). 5) Artificial nutrition, intravenous hydration and oral nutrition can be proposed to bone-marrow transplant recipients (option). 6) There is no standard modality for artificial nutrition (level of evidence B 1). Exclusive enteral or parenteral nutrition and enteral plus parenteral nutrition may be proposed to bone-marrow transplant patients (options). 7) Lipid intake representing up to 30% of the non-protein caloric intake should be supplied to patients undergoing bone marrow transplantation (standard, level of evidence B1). 8) Oral supplementation with nitrogen substrates or glutamine is not recommended. Parenteral glutamine supplementation may be proposed (option).
Raynard
Bruno
B
FNCLCC, Standards, Options, Recommandations, 101, rue de Tolbiac, 75654 Paris Cedex 13.
Nitenberg
Gérard
G
Gory-Delabaere
Guillaume
G
Bourhis
Jean-Henry
JH
Bachmann
Patrick
P
Bensadoun
René-Jean
RJ
Desport
Jean-Claude
JC
Kere
David
D
Schneider
Stéphane
S
Senesse
Pierre
P
Bordigoni
Pierre
P
Dieu
Lise
L
D000465:Algorithms; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage; D001835:Body Weight; D016026:Bone Marrow Transplantation; D004041:Dietary Fats / Q000008:administration & dosage; D004435:Eating; D002149:Energy Intake; D004750:Enteral Nutrition; D005973:Glutamine / Q000008:administration & dosage; D006801:Humans; D015596:Nutrition Assessment; D018529:Nutritional Support / Q000592:standards*; D010288:Parenteral Nutrition; D016032:Randomized Controlled Trials as Topic
D000597:Amino Acids, Branched-Chain; D004041:Dietary Fats; D005973:Glutamine