Better early outcome with enteral rather than parenteral nutrition in children undergoing MAC allo-SCT

Gonzales, Fanny; Bruno, Bénédicte; Fuentes, Mendoza; Berranger, Eva de; Guimber, D.; Behal, Hélène; Gandemer, Virginie; Spiegel, Adam; Sîrvent, Anne; Yakoub-Agha, Ibrahim; Nelken, Brigitte; Duhamel, Alain; Séguy, D.

doi:10.1016/j.clnu.2017.10.005

Cited by 44 publications

(95 citation statements)

References 42 publications

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“…However, these recommendations are based on weak evidence (8). Consequently, clinical practices deviate widely (16,17), with centres lacking nutrition support protocols (18) and continuing to use first-line PN (19).…”

Section: Rationalementioning

confidence: 99%

“…All studies were in English with two 15-20 years old (37,38), and ranged from one year (38), to 11 (19) in duration. All were single-centre studies conducted in Europe, except one multi-centre study (19), and one undertaken in Brazil (39).…”

Section: Settings and Designsmentioning

confidence: 99%

“…Designs were mostly cohort studies conducted prospectively (37,40), or retrospectively (19), with the latter matching children on relevant covariates. One study attempted an RCT, but due to nasogastric tube refusals, participants who did and did not consent to randomization were combined, thus resulting in a quasi-randomized study (38).…”

Section: Settings and Designsmentioning

confidence: 99%

“…Children had malignant and non-malignant diseases and received various conditioning regimens, except in two studies which focused on those receiving myeloablative conditioning (19,40). No studies reported sample size calculations and samples were generally small, from 34 (38) to 194 (19), with 449 participants included in this review.…”

Section: Participantsmentioning

confidence: 99%

“…Although two studies only mentioned 'tube feeding' without stating the tube type (38,39), most used nasogastric tubes. However, differences existed is timing of EN initiation, which was either started systematically the day after HSCT (19,40), when oral intake provided 75% requirements on three consecutive days (38), or when a child lost >5% of admission weight and/or 10% decrease in midupper-arm circumference (MUAC) (37). PN was initiated systematically the day following HSCT (19).…”

Section: Interventionsmentioning

confidence: 99%

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Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Evans

Hirani

Needle

2019

Biology of Blood and Marrow Transplantation

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Background: Hematopoietic stem cell transplantation (HSCT) involves the administration of chemotherapy followed by the infusion of donor stem cells. After treatment, children can consequently experience nausea, vomiting, diarrhea, anorexia and mucositis, which negatively impact oral intake leading to rapid deterioration in nutritional status and risk of malnutrition. Nutrition support therefore becomes necessary to circumvent these adverse effects. This has traditionally been provided via parenteral nutrition (PN), but pediatric evidence is increasingly advocating enteral nutrition (EN) as a preferential alternative. The objective of this review is to determine the efficacy of any forms of EN vs. PN provided during admission to children ≤18 years undergoing HSCT. Primary outcomes considered efficacy in relation to various nutritional parameters, and secondary outcomes included a range of posttransplantation parameters. Methods: Data sources included English and non-English articles from the start date of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Controlled Trials register, up to July 2018. Key journals were also hand searched, reference lists scanned, clinical experts contacted and grey literature searched using EThOS and Open Grey. Randomized and observational studies comparing any forms of EN vs.PN in children ≤18 years undergoing HSCT investigating nutritional or post-transplantation outcomes were eligible. Data were extracted from included studies using a custom extraction form that had previously been piloted. As included studies were observational, risk of bias was assessed using ROBINS-I. Results:As only a small number of heterogenous studies reporting a wide range of differently defined outcomes were included, meta-analyses were not performed and data were presented in narrative form.Conflicting results in favor of either method of nutrition support, or no difference between methods, were seen for duration of interventions, nutritional intakes, biochemical and anthropometric changes, mortality, infections, length of admission and neutrophil engraftment. EN may provide favorable benefits over PN regarding acute graft-versus-host-disease (aGvHD) and platelet engraftment. Discussion:A paucity of studies were found investigating the question posed by this review. Included studies were clinically heterogenous regarding populations, interventions and outcomes, at moderate to serious risk of bias due to the absence of randomization, confounding parameters, statistical control, retrospective designs and participant selection. Some studies were more than 15 years old.Conclusions: Despite the limited number and poor quality of identified studies, results support the growing body of pediatric evidence that EN is feasible during HSCT. Similar differences regarding many nutritional and post-transplantation outcomes were seen in both forms of nutrition support, but EN could provide benefits above PN including reduced incidence of aGvHD and faster platelet engraftment.

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Section: Rationalementioning

confidence: 99%

Section: Settings and Designsmentioning

confidence: 99%

Section: Settings and Designsmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

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Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Evans

Hirani

Needle

2019

Biology of Blood and Marrow Transplantation

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Gut microbiota, microbiota‐derived metabolites, and graft‐versus‐host disease

Yue,

Zhou,

Wang

et al. 2024

Cancer Medicine

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Allogeneic hematopoietic stem cell transplantation is one of the most effective treatment strategies for leukemia, lymphoma, and other hematologic malignancies. However, graft‐versus‐host disease (GVHD) can significantly reduce the survival rate and quality of life of patients after transplantation, and is therefore the greatest obstacle to transplantation. The recent development of new technologies, including high‐throughput sequencing, metabolomics, and others, has facilitated great progress in understanding the complex interactions between gut microbiota, microbiota‐derived metabolites, and the host. Of these interactions, the relationship between gut microbiota, microbial‐associated metabolites, and GVHD has been most intensively researched. Studies have shown that GVHD patients often suffer from gut microbiota dysbiosis, which mainly manifests as decreased microbial diversity and changes in microbial composition and microbiota‐derived metabolites, both of which are significant predictors of poor prognosis in GVHD patients. Therefore, the purpose of this review is to summarize what is known regarding changes in gut microbiota and microbiota‐derived metabolites in GVHD, their relationship to GVHD prognosis, and corresponding clinical strategies designed to prevent microbial dysregulation and facilitate treatment of GVHD.

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Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant

et al. 2021

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Background: Nutrition support is essential in children with cancer, including those undergoing bone marrow transplant (BMT), to reduce the risk of malnutrition and associated deleterious outcomes. Enteral nutrition is more commonly provided via nasogastric than gastrostomy tubes because of safety concerns with the latter in immunocompromised children. This systematic review investigated the incidence and type of complications and outcomes in pediatric cancer patients fed by gastrostomy. Methods: Databases were searched for randomized and observational studies investigating the use of any gastrostomy device in children aged <18 years with any cancer diagnosis, including those undergoing BMT. Five cohort and 11 case series studies were included. Owing to clinical heterogeneity, meta-analyses were not performed.Results: Quality of evidence varied, with five studies judged at serious risk of bias and poor quality; however, the remaining 11 were considered to range from moderate to good quality. Across studies, 54.6% of children developed one or more complications, of which 76.6% were classified as minor, 23.4% major. The most frequent complications included inflammation (52% of episodes), infection (42.1%), leakage (22.3%), and granuloma (21%). Evidence regarding infection rates in cancer/BMT patients compared with other disease states was inconclusive.Gastrostomy feeding was associated with improvement or stabilization of nutrition status in 77%-92.7% of children.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Better early outcome with enteral rather than parenteral nutrition in children undergoing MAC allo-SCT

Cited by 44 publications

References 42 publications

Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Gut microbiota, microbiota‐derived metabolites, and graft‐versus‐host disease

Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant

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