title: Audit of nutrition support for hematopoietic stem cell transplantation at a single institution.
abstract: OBJECTIVE
  To analyze experience with total parenteral nutrition (TPN) for hematopoietic stem cell transplantation (HSCT) at our institution compared with reports in the literature.
  
  
  METHODS
  We reviewed medical records of 100 patients (53 men and 47 women) who underwent HSCT from 1992 to 2001. Data were abstracted on demographics, primary diagnosis, type of transplantation, myeloablative regimen, length of hospital stay, time to engraftment, 1- and 5-year survival, initiation and duration of TPN, and TPN-related complications.
  
  
  RESULTS
  Seventy-one transplantations were autologous, 27 allogeneic, and 2 syngeneic. The median age of the patients was 51 years (range, 19-71 years). We initiated TPN when patients' oral caloric intake was less than 50% of their estimated needs (4 to 7 days after the start of myeloablative therapy; median, 1.2 days after HSCT; range, 8 days before HSCT to 13 days after HSCT). We discontinued TPN when oral intake was more than 50% of estimated needs (median duration, 16 days for autologous and 24 days for allogeneic transplantations, with the shortest duration in breast cancer patients and the longest duration in those treated with cyclophosphamide). Mean weight loss was less than 2%. No differences in patient characteristics, myeloablative regimen, or diagnosis were observed between patients who required and those who did not require TPN. Infection, hospital stay, time to engraftment, and mortality were comparable to published reports.
  
  
  CONCLUSIONS
  In patients undergoing HSCT, TPN should not be initiated until oral caloric intake is less than 50% of estimated needs. During the period of inadequate oral intake, TPN maintains stable body weight with longer duration of support needed for patients undergoing allogeneic than for those undergoing autologous transplantations.
authors.affiliation: Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, Jacksonville, Fla 32224, USA. scolapio.james@mayo.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Scolapio
authors.forename: Vilia B
authors.initials: VB
authors.lastname: Tarrosa
authors.forename: Gary L
authors.initials: GL
authors.lastname: Stoner
authors.forename: Alvaro
authors.initials: A
authors.lastname: Moreno-Aspitia
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Solberg
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Atkinson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D018529:Nutritional Support; D010289:Parenteral Nutrition, Total; D013997:Time Factors; D016896:Treatment Outcome