Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

Abstract

Summary:Patients with hematological malignancies are well nourished prior to allogeneic hematopoietic stem cell transplantation (HSCT). HSCT and associated complications can affect body composition. The study evaluated crosssectionally the prevalence and longitudinally the changes in lean body mass index (LBMI) in HSCT patients. Patients (n ¼ 82) were classified as normal or low LBMI. Logistic regression analyses were used to estimate odds ratios (OR) for low vs normal LBMI, between healthy volunteers and patients; for limited or extensive vs no chronic graft-versus-host-disease (GVHD); and for decreased (Karnofsky o80) vs normal functional status (480). Patients were significantly more likely to have low LBMI at 6, 12 months, 2-3, 4-6 and 46 years than volunteers. In all, 38% of patients were below pre-HSCT LBMI at 4-6 years post-HSCT. Low LBMI was significantly associated with steroid treatment (OR 2.6, confidence intervals (CI) 1.3-5.2, P ¼ 0.008); limited (OR 5.5, CI 1.7-18.5, P ¼ 0.005) or extensive chronic GVHD (OR 20.3,, Po0.001); and decreased performance status (Karnofsky scores of p80) (OR 2.7, CI 1.3-5.9, P ¼ 0.01). Patients were more likely to have low LBMI than volunteers. Chronic GVHD and low performance status were associated with low LBMI; thus, complications and/or treatment increase the likelihood of low LBMI. Patients with hematological malignancies are usually well nourished at the time of allogeneic hematopoietic stem cell transplantation (HSCT). 1,2 However, nutritional consequences after HSCT have not been well studied. Underweight patients are at increased risk of death in the early post-HSCT period, and nonrelapse mortality is greater for extremely underweight or overweight patients. 3,4 High body mass index (BMI), weight normalized for height, may also affect treatment-related toxicity and mortality. 5 Furthermore, low lean body mass (LBM) has been associated with poor outcome and increased length of hospital stay. 6 Allogeneic HSCT and associated complications, including infections and graft-versus-host-disease (GVHD), can affect body weight and body composition. Immunosuppressive therapy after transplantation has been shown to alter skeletal muscle metabolism. 7 Corticosteroids promote muscle atrophy by increasing the rate of protein catabolism, amino-acid efflux, while simultaneously decreasing the rate of protein synthesis. 8 Thus, treatment and complications following HSCT exert profound negative effects on LBM.As low LBM is associated with poor outcome, the evaluation of LBM and body fat changes in pre-and post-HSCT patients can aid in adapting nutrition policy, for example, nutrition support in malnutrition and food restriction in obesity. 9 Just as BMI is useful in evaluating the excess or deficit in body weight in individuals of different heights, the lean body mass index (LBMI, kg/m 2 ) and body fat mass index (BFMI, kg/m 2 ) are potentially useful in evaluating body composition parameters by effectively eliminating differences in LBM and body fat with height. 10 Height-indepe...

Telephone-delivered nutrition and exercise counselling after auto-SCT: a pilot, randomised controlled trial

“…Loss of fat may be temporary. Results on adult 32 and paediatric 33 PBSC transplantation survivors (both ⩾ 4-6 years survival), and breast cancer survivors (⩾6 months survival) 34 showed weight recovery favoured fat gain over LBM. This trend of change is not desirable as excess FM can mask a LBM deficit, as well as increase the risks of overweight-related health issues.…”

Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation

“…55,56 Moreover, Lenssen et al 9 reported Course of nutritional status in alloHCT P Urbain et al that the frequency of depleted muscle reserves rose independently of weight changes during the first post-transplant year in alloHCT recipients. Kyle et al 11 even showed that any loss of weight and lean body mass experienced during the immediate post-transplant period (reflecting muscle mass among other factors) is not regained during the first year. Possible explanatory models include among others decline in physical activities for up to 1 year after transplantation, 9 a negative energy balance due to hypermetabolism, and the catabolic effects on skeletal muscle exerted by medication with corticosteroids 5,6 as well as immunosuppressive drugs.…”

“…[7][8][9][10] To date, few studies have assessed nutritional status before alloHCT, and most of them only recorded body mass index (BMI) as a potential risk factor for survival. [7][8][9][10] Except for one report by Kyle et al 11 on the development of lean body mass, there were until now no longitudinal data on nutritional status and body composition in the early post-transplant period, although several reports showed that depletion of micronutrients, mainly vitamin D, is common before and after alloHCT. [12][13][14] There are now many nutritional parameters available and validated for cancer patients.…”

Nutritional support in patients with GVHD of the digestive tract: state of the art

“…In particular patients with chronic (c)GVHD had a significantly lower LBM index, and steroid treatment was associated with a lower LBM index and a higher body fat mass index. 12 In a small prospective study (n ¼ 47 patients who underwent allo-SCT), around 50% of patients experienced diarrhoea at median of 10 days after allo-SCT; diarrhoea had a profound negative effect on nutritional status and well-being, despite the administration of TPN in the majority of those patients. 11 A few studies investigated nutritional status in patients with GVHD, and looked at differences between subgroups with limited and extensive (or active and inactive) GVHD.…”

“…11,12 A large prospective study of high quality showed allo-SCT patients had a lower LBM index than healthy controls, at 6 and 12 months up to 6 years post transplant. In particular patients with chronic (c)GVHD had a significantly lower LBM index, and steroid treatment was associated with a lower LBM index and a higher body fat mass index.…”