Summary:Among healthcare professionals there is no consensus about the best policy to increase oral intake and promote recovery in the post-hospital phase after bone marrow or blood stem cell transplantation. In order to evaluate body weight recovery and compliance with dietary advice among these patients, we performed a prospective longitudinal study in the first year post transplant. At five time intervals (days 50, 75, 125, 200 and 350) patients received a nutritional questionnaire with items on nutrition-related symptoms, physical condition, body weight recovery and compliance with dietary advice. From the initial cohort of 135 patients 69 completed the study. Prevalence of eating difficulties was high (66% at day 50). Anorexia, dry mouth, altered taste, nausea and tiredness were the symptoms most strongly associated with eating difficulties. Compliance with dietary advice was poor. Conditioning regimen was found to be a prognostic factor for body weight status at day 350. In more than 50% of the TBI-treated patients body weight was not restored to 95% of the pretreatment value within 1 year after transplant. Future studies should focus on increasing energy and protein intake in the TBI-treated subgroup. Bone Marrow Transplantation (2002) 29, 417-424. DOI: 10.1038/sj/bmt/1703375 Keywords: body weight; gastro-intestinal complaints; nutrition; oral supplements; dietary compliance Current indications for bone marrow transplantation (BMT) and peripheral blood cell transplantation (BCT) include not only haematological malignancies but also solid tumours (breast carcinoma, childhood sarcomas) and non-malignant diseases such as scleroderma. The spectrum of conditioning

Summary:Patients receiving intensive cytotoxic therapy are traditionally supported with parenteral nutrition (PN), although it is unclear whether all patients benefit from PN. This study aimed to identify regimen-associated differences in PN requirements, to reveal discrepancies between the number of PN indications and the frequency with which PN was actually given, and to describe characteristics of patients who met nutritional goals without PN. PN indications were defined as: (1) severe malnutrition at admission; (2) a prolonged period (7-10 days) of minimal oral intake; or (3) clinical weight loss Ͼ10%. PN was found to be needed in only 35% of consolidation courses, compared with 80% during remission induction and 55% during BMT. Significant differences were also seen between BMT protocols: PN was required in only 37% of autologous BMT recipients conditioned without total body irradiation (for lymphoma) vs 92% of recipients of a mismatched graft. A high body mass index was the only significant characteristic of patients who could do without PN. In conclusion, PN is not required for all patients undergoing intensive cytotoxic therapy. Screening of nutritional status at the start of therapy and monitoring oral intake following cytotoxic treatment may allow more appropriate identification of patients requiring PN. Keywords: parenteral nutrition; leukaemia; lymphoma; cancer chemotherapy; bone marrow transplantation Since parenteral nutrition was shown to be safe and feasible in patients undergoing bone marrow transplantation, 1,2 it has been widely used in patients undergoing intensive cytotoxic therapy. Parenteral nutrition support (PNS) was believed to be indispensible in bridging the period of severe gastrointestinal toxicity and pancytopenia. [3][4][5][6][7][8] Despite this, the efficacy of PNS on treatment tolerance or prognosis has never been demonstrated. Recent developments, such as the advent of improved antiemetics and haematopoietic growth Correspondence: JA Iestra, Center for Rehabilitation and Nutritional Sciences, University Hospital Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands Received 23 July 1998; accepted 3 December 1998 factors, have shortened the period of reduced oral food intake. In addition, more awareness has grown of the disadvantages of PNS in terms of complication risk and costs.Recent clinical guidelines 9,10 advocate reserving PNS for those cancer patients not tolerating enteral nutrition support, who are either severely malnourished on admission or who are expected to undergo a prolonged period (more than 7 to 10 days) of inadequate oral intake.To define the need for PNS in patients receiving different cytotoxic regimens we retrospectively studied the occurrence of both indications. We added a third indication, that of more than 10% weight loss during admission. We investigated the frequency of 'malnutrition at the start of therapy', 'a prolonged period of inadequate oral intake' and 'severe clinical weight loss' occurring either during the clinical phases (remission induc...