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

Adverse changes in nutrition-related outcomes including quality of life (QoL) occur after PBSC transplantation. This randomised controlled trial aims to evaluate the impact of nutrition and exercise counselling provided at hospital discharge on nutritional status, body composition and QoL post transplantation. Usual care (UC) (n = 19) received no intervention after discharge; extended care (EC) (n = 18) received fortnightly telephone counselling from a dietitian and exercise physiologist up to 100 days post transplantation. Nutritional status (patient-generated subjective global assessment, and diet history), QoL (EORTC QLQ-C30 version 3) and body composition (air displacement plethysmography) were assessed at pre-admission, discharge and 100 days post transplantation. Intervention groups were compared using two-sample t-tests of changes in the outcomes; results were adjusted using analysis of covariance. EC exhibited clinically important but not statistically significant increases in protein intake (14.7 g; confidence interval (CI) 95% − 6.5, 35.9, P = 0.165), cognitive functioning (7.2; CI 95% − 7.9, 22.2, P = 0.337) and social functioning (16.5; CI 95% − 7.3, 40.3, P = 0.165) compared with UC. Relative to pre-admission, EC experienced less weight loss than UC (−3.3 kg; CI 95% − 6.7, 0.2, P = 0.062). Physical activity was not significantly different between the groups. Ongoing nutrition and exercise counselling may prevent further weight loss and improve dietary intake and certain QoL components in autologous PBSC transplantation patients following hospitalisation.

Section: Discussionmentioning

confidence: 99%

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

Hung

Bauer

Horsely

et al. 2014

“…Furthermore, it might be very important in future studies to link physical activity behavior with the nutritional status of HCT patients 30,31 to obtain more insight into the relation between those two aspects. With regard to methodological aspects, our results also emphasize that baseline fitness levels should be considered as a stratifying criterion in randomization procedures to preclude a fitness bias in statistical analyses of clinical exercise trials.…”

Section: Exercise In Allo-hct Patients-who Benefits Most? J Wiskemannmentioning

confidence: 99%

Efficacy of exercise training in SCT patients-who benefits most?

Wiskemann

Kuehl

Dreger

et al. 2013

Patients undergoing allo-HCT often experience a substantial loss in physical performance. We have recently published the general effectiveness of an exercise intervention in 105 allo-HCT patients on physical performance and psychosocial well-being. However, predictor variables for differentiated treatment response remained unclear. To determine the impact of basic physical performance on treatment response, we assessed muscle strength and endurance performance at four assessment points before and after allo-HCT. The exercise group started training 2 weeks before admission and ended 6-8 weeks after discharge. Comparing initially fit with unfit classified patients, the fit patients lost 31% of the strength of the knee-extensors, whereas the unfit patients lost only 1% (Po0.05). For endurance capacity, fit patients lost 4% of their walking capability, whereas unfit patients gained 13% (Po0.05). The individual percent change was statistically different at the 0.05 level in all measures of physical performance. Individual training response in allo-HCT patients strongly depends on the initial physical performance level. Unfit patients can be trained safely and may benefit more from this exercise intervention than fit patients. This result is of major clinical relevance and should encourage hematologists to promote exercise even more in impaired/unfit allo-HCT patients.

“…[2][3][4] Lenssen et al have reported that long-term survivors experienced weight loss, especially after 100 days post-transplant. 2 One major cause of weight loss was insufficient caloric intake.…”

Section: Introductionmentioning

confidence: 99%

Severe weight loss in 3 months after allogeneic hematopoietic SCT was associated with an increased risk of subsequent non-relapse mortality

Fuji¹,

Mori

Khattry

et al. 2014

Patients after allogeneic hematopoietic SCT (HSCT) are at risk of malnutrition. To assess the impact of malnutrition after allogeneic HSCT on transplant outcomes, we conducted a retrospective study. Adult patients who received allogeneic HSCT from 2000 to 2009 for standard-risk leukemia and achieved disease-free survival up to 3 months after allogeneic HSCT were included. From participating centers, 145 patients were enrolled. Median age was 46 years (19-68). Patients were classified based on weight loss during 3 months after allogeneic HSCT as follows: normal group (weight loss o 5%, n = 53), mild malnutrition group (5% ⩽ weight loss o 10%, n = 47), severe malnutrition group (10% ⩽ weight loss, n = 45). The cumulative incidences of 2-year nonrelapse mortality (NRM) were 3.8% in the normal group, 8.5% in the mild malnutrition group and 27.3% in the severe malnutrition group. The probabilities of a 2-year OS were 73.2% in the normal group, 74.5% in the mild malnutrition group and 55.3% in the severe malnutrition group. In multivariate analysis, severe malnutrition was associated with an increased risk of NRM and a worse OS. In conclusion, weight loss ⩾ 10% was associated with a worse clinical outcome. Prospective studies that identify patients at risk of malnutrition and intervention by a nutritional support team are warranted.