Challenging and Practical Aspects of Nutrition in Chronic Graft-versus-Host Disease

The Promise of Precision Nutrition for Modulation of the Gut Microbiota as a Novel Therapeutic Approach to Acute Graft-versus-host Disease

“…Recent evidence suggests the importance of an adequate intake of micronutrients to reduce GVHD comorbidities, such as muscle mass loss, ocular manifestations, and osteoporosis, with adequate intake of vitamins A and D, zinc, magnesium and potassium, omega-3 fatty acids, and probiotics found to be of particular importance. 29 Specific nutrients are described as immune system modulators if supplemented in the nutritional therapy after transplantation. These supplements include glutamine to improve enterocyte metabolism, eicosapentaenoic acid to reduce levels of the proinflammatory cytokines, interleukin 6 and leukotriene B4, N-acetylcysteine to protect hepatocytes and scavenge free radicals, and selenium for its antioxidant properties and to reduce levels of interleukins and tumor necrosis factor.…”

“…130 Magnesium supplementation is recommended in GVHD patients when deficient. 29 The intake of omega-3 fatty acids shows beneficial effects as well for GVHD 29,131 and clinical trials testing omega-3rich foods and supplements in healthy subjects showed beneficial effects on the gut microbiota and the lipids profile, increasing SCFA-producing bacteria. [132][133][134] Finally, glutamine is usually supplemented to allo-HSCT patients, and, as mentioned above, it reduces mucositis, diarrhea, and the duration of EN, and it improves weight loss in combination with the prebiotic oligosaccharides and dietary fibers.…”

The clinical landscape of chronic graft‐versus‐host disease management in 2021

“…Further, for patients who develop significant toxicity from systemic treatment, maximizing topical therapies reaps benefits by way of allowing systemic IST dose reduction. A multidisciplinary approach in treatment that incorporates ancillary and supportive care is recommended, with close and consistent specialty follow‐up with experts familiar with cGVHD management including ophthalmology, dermatology, oral medicine, wound care, gynaecology, and nutrition 98 (Fig 2). There is a dearth of controlled studies or reports of topical therapy for cGVHD.…”