Blood and marrow transplantation and nutritional support.
BACKGROUND
Undernourishment on hospital admission has been considered as risk factor for complications and increased relapse/nonrelapse mortality in hematopoietic stem cell transplantation (HSCT) patients.


METHODS
All patients undergoing HSCT are at an increased risk for malnutrition. The changes in these patients affect mainly protein, energy, and micronutrient metabolism. Nutrition support recommendations are now based on the nutritional status of the individual patient, and total parenteral nutrition is no longer indicated for all HSCT patients. As long as it is possible, an oral route should be use in feeding to avoid complications. When total parenteral nutrition (TPN) should be started is one of the most controversial issues. The following indications for TPN are now generally accepted: severe malnutrition at admission (BMI < 18.5) or weight loss > 10% during treatment or impossibility of oral feeding or failing to meet 60-70% of the requirements over 3 days. Specialized nutritional support containing glutamine or immunomodulatory formulas such as arginine, ω3 polyunsaturated fatty acids, purine/pyrimidines (RNA) may be useful.


RESULTS
The complications of TPN are divided into metabolic and those related to central venous catheter. TPN should be progressively decreased while increasing feedings by the oral route. When the patients can cover ≥50% of the daily energy requirements orally (for greater than 5 days), withdrawal of TPN may be appropriate. In patients who have suffered from graft-versus-host disease (GvHD) with intestinal involvement, TPN should be used until the stool volume decreases to <500 ml/day for at least 2 days.


CONCLUSIONS
Parenteral nutrition allows better modulation of fluid, electrolytes, and nutrient administration which can be of critical importance when complications such as GvHD or VOD arise.
Rzepecki
Piotr
P
Military Institute of Health Services, Warsaw, Poland. piotr_rzepecki@poczta.onet.pl
Barzal
Justyna
J
Oborska
Sylwia
S
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000379:methods; D005973:Glutamine / Q000008:administration & dosage / Q000378:metabolism; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D056747:Immunomodulation; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control*; D018529:Nutritional Support / Q000379:methods*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects
D005973:Glutamine