Naso-jejunal feeding in allogeneic bone marrow transplant recipients: results of a pilot study

Abstract

Summary:Patients undergoing allogeneic bone marrow transplants (BMT) are often malnourished prior to commencing the procedure. They face intensive treatment with often marked nutritional consequences. There is no consensus on the optimal nutritional management of these patients. Elective parenteral nutrition (PN), beginning pre-transplant irrespective of the patients nutritional status, or the use of 'salvage' PN, beginning during the post-transplant period if the patient fails to maintain nutritional status with oral diet, have been used. Enteral nutrition may benefit the patient by maintaining nutritional support throughout the transplant period, avoiding the complications and expense of PN and possibly, by using specific diets, protecting the gastrointestinal tract from the effects of chemoradiation. However, naso-gastric feeding during a transplant is not without risks, including the safe insertion of a tube in patients with mucositis and pan-cytopenias, tube displacement by vomiting and aspiration from gastro-oesophageal reflux. An alternative approach is to use nasojejunal (NJ) feeding tubes which are associated with less risk of loss due to vomiting and less risk of aspiration. We report a pilot study of 15 allogeneic BMT patients who had elective NJ feeding initiated before conditioning therapy irrespective of perceived nutritional compromise. This was well tolerated and feasible with a motivated nutritional team. Bone Marrow Transplantation (2001) 28, 1135-1139. Keywords: allogeneic bone marrow transplant; enteral feeding; naso-jejunal feeding tubes; pilot study Patients undergoing BMT are often under-nourished due to previous chemotherapy and the underlying disease process. They face a long hospital stay and intensive conditioning therapy, which can have marked nutritional consequences. Subsequent complications such as infections, veno-occlus-

Better Outcome of Patients Undergoing Enteral Tube Feeding After Myeloablative Conditioning for Allogeneic Stem Cell Transplantation

“…One of the limitations of EN was vomiting, possibly related to the toxicity of conditioning and/or gastroparesis after SCT (23,24). The following moves improved tolerance to EN: 1) deferral of feeding tube insertion until the end of conditioningVideally the day after transplantation but before the onset of mucositisVleading to satisfactory tolerance of the device; 2) use of an NGT rather than a nasojejunal tube because of its ease of installation; and 3) a gradual increase in the infused volume, which may have overcome the gastroparesis effect (16,20).…”

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

“…(Grade: C) Rationale: Use of peri-transplant EN after conditioning regimens has been investigated. [150][151][152][158][159][160] Studies have included small numbers of patients receiving enteral feeding or oral intake compared to PN alone or in combination of EN or PN, which makes evaluation of clinical outcomes difficult. In general, less diarrhea and less hyperglycemia (defined as blood glucose >110-150 mg/dL) have been reported in patients receiving EN.…”

Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay

“…[1][2][3] Disease status, time of last chemotherapy, infections and anorexia can have a significant impact on nutritional status prior to undergoing HSCT. Malnutrition prior to transplant has been reported as being a negative prognostic factor for survival following HSCT.…”