title: Malnutrition in patients with chronic GVHD.
abstract: Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had long-standing, moderate or severe cGVHD and had failed many lines of therapy. Twenty-nine percent (60/210) of subjects were malnourished, using the subjective Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and evaluation. No demographic or transplant characteristics were associated with malnutrition; cGVHD of the lungs, gastrointestinal (GI) tract and mouth, NIH global score, cGVHD symptoms, worse functioning, low albumin, poorer survival and low BMI were associated with malnutrition. A predictive model was developed from all variables of significance: cGVHD of the lungs, GI tract, mouth and BMI accurately predicted 84.2% of malnourished patients as well as 87.2% of well-nourished patients. The PG-SGA questionnaire may be a useful tool in diagnosing nutritional deficits in cGVHD patients undergoing one-time evaluations. Longitudinal prospective studies should assess the utility of nutritional support interventions in cGVHD.
authors.affiliation: Clinical Research Center, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Bassim
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: H
authors.initials: H
authors.lastname: Fassil
authors.affiliation: Nutrition Department, National Institutes of Health, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Dobbin
authors.affiliation: Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: K
authors.initials: K
authors.lastname: Baird
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: K
authors.initials: K
authors.lastname: Cole
authors.affiliation: Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA.
authors.forename: G
authors.initials: G
authors.lastname: Joe
authors.affiliation: Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Comis
authors.affiliation: Outcomes Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Mitchell
authors.affiliation: 1] Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA [2] Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: L
authors.initials: L
authors.lastname: Grkovic
authors.affiliation: Clinical Research Center, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
authors.forename: D
authors.initials: D
authors.lastname: Edwards
authors.affiliation: Clinical Research Center, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Mays
authors.affiliation: Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: E W
authors.initials: EW
authors.lastname: Cowen
authors.affiliation: 1] Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA [2] Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: D
authors.initials: D
authors.lastname: Pulanic
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Gress
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: S Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D055815:Young Adult