Association of Nutritional Parameters with Clinical Outcomes in Patients with Acute Myeloid Leukemia Undergoing Haematopoietic Stem Cell Transplantation

Abstract

Introduction: In acute myeloid leukemia (AML) patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT), there is uncertainty about the extent of influence nutritional parameters have on clinical outcomes. In this study, we investigated the association between initial body mass index (BMI) and weight loss during HSCT on clinical outcomes in a well-characterised cohort of AML patients. Methods: We analysed data of the Basel stem-cell transplantation registry (‘KMT Kohorte') including all patients with AML undergoing first allogeneic HSCT from January 2003 to January 2014. We used multivariable regression models adjusted for prognostic indicators (European Group for Blood and Marrow Transplantation risk score and cytogenetics). Results: Mortality in the 156 AML patients (46% female, mean age 46 years) over the 10 years of follow-up was 57%. Compared to patients with a baseline BMI (kg/m²) of 20-25, a low BMI <20 was associated with higher long-term mortality (70 vs. 49%, adjusted hazard ratio 1.97, 95% CI 1.04-3.71, p = 0.036). A more pronounced weight loss during HSCT (>7 vs. <2%) was associated with higher risk for bacterial infections (52 vs. 28%, OR 2.8, 95% CI 0.96-8.18, p = 0.059) and fungal infections (48 vs. 23%, OR 3.37, 95% CI 1.11-10.19, p = 0.032), and longer hospital stays (64 vs. 38 days, adjusted mean difference 25.6 days (15.7-35.5), p < 0.001). Conclusion: In patients with AML, low initial BMI and more pronounced weight loss during HSCT are strong prognostic indicators associated with lower survival and worse disease outcomes. Intervention research is needed to investigate whether nutritional therapy can reverse these associations.

Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review

“…72 Our own retrospective study did as well show a correlation of high weight loss during the index hospitalization and increased morbidity and length of hospital stay. 73 However, we also found an association of low pretransplantation body weight with mortality. 73 The result is supported by Xue et al 74 documenting lower survival in underweight patients before transplantation in another retrospective analysis.…”

“…73 However, we also found an association of low pretransplantation body weight with mortality. 73 The result is supported by Xue et al 74 documenting lower survival in underweight patients before transplantation in another retrospective analysis. Dietrich et al 75 examined the association of BMI before the beginning of induction chemotherapy and BMI before transplantation with survival.…”

Enteral nutrition protects children undergoing allogeneic hematopoietic stem cell transplantation from blood stream infections

“…Currently, there is no consensus regarding which parameter best determines malnutrition in children undergoing allo-HSCT. Body weight and BMI are easily applicable in clinical practice, but lack information on body composition and are heavily influenced by hydro-electrolytic imbalance occurring during the procedure, thus not directly reflecting the patient's nutritional status [5,6,36,37]. Additional studies comparing laboratory parameters, such as retinol-binding protein, or more detailed anthropometric measures, for example triceps skin fold thickness, are needed to better understand the influence of the type of nutritional support on overall patient nutritional status.…”

Impact of Body Mass Index on Outcomes of Hematopoietic Stem Cell Transplantation in Adults

“…Attempts to improve nutrition in underweight patients before or during transplantation have been proposed. Baumgartner et al [6] compared 90 adult AML patients who underwent myeloablative transplants and received PN with patients who did not receive nutritional therapy and showed that the patients who received PN had higher mortality, more infectious complications, and a greater risk of GVHD.…”