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


OBJECTIVE
We propose to compare the impact of EN versus PN on early outcome after allo-HSCT.


METHODS
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.


RESULTS
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%).


CONCLUSIONS
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.
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France. Electronic address: rguieze@chu-clermontferrand.fr.
Romain
R
Guièze
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France.
Richard
R
Lemal
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France.
Aurélie
A
Cabrespine
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France.
Eric
E
Hermet
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France.
Olivier
O
Tournilhac
CHU Clermont-Ferrand, Service Diététique, F-63003 Clermont-Ferrand, France.
Cécile
C
Combal
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France.
Jacques-Olivier
JO
Bay
CHU Clermont-Ferrand, Service de Médecine Digestive et Hépatobiliaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000 Clermont-Ferrand, France; INRA, UMR 1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France.
Corinne
C
Bouteloup
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D015992:Body Mass Index; D036262:Empirical Research; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents
Enteral tube feeding; Haematological malignancies; Infectious complications; Supportive care