Nutrition Challenges in a Patient With Sinusoidal Obstructive Syndrome Following an Allogeneic Stem Cell Transplant

Abstract

Nutrition management of patients undergoing a hematopoietic stem cell transplant (HSCT) can be challenging. Fluid, macronutrient, and micronutrient needs are often altered due to a variety of therapy-associated complications and changes in metabolism. Sinusoidal obstructive syndrome (SOS) is a complication characterized by fluid retention, ascites, and painful hepatomegaly that may complicate provision of adequate nutrition to HSCT patients. The nutrition implications and interventions in a patient who developed SOS following an allogeneic matched unrelated donor (Allo/MUD) HSCT are reviewed in the case report.

Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review

“…VOD may ultimately limit MNT provision because of increases in intra-abdominal pressure. 29 Novel adoptive immunotherapy in HM, such as chimeric antigen receptor (CAR) T-cell (CAR-T) therapy, has emerged in refractory or relapsed HM as a rescue strategy. 30 Unfortunately, it is also associated with severe side effects, the most common of which is cytokine release syndrome (CRS).…”

“…Another liver‐related HSCT complication is venoocclusive disease (VOD) due to sinusoidal obstruction, which may cause fluid retention, ascites, and painful hepatomegaly. VOD may ultimately limit MNT provision because of increases in intra‐abdominal pressure 29 …”

Overview of nutritional approach in hematopoietic stem cell transplantation: COVID-19 update

“…Sinusoidal obstructive syndrome is a common and high-risk complication of HSCT. The syndrome is characterized by hyperbilirubinemia, jaundice, weight gain, ascites and painful hepatomegaly, which develops 10–20 d after initiation of cyclophosphamide-based cytoreductive therapy and later after other myeloablative regimens[ 73 ].…”

“…Its treatment is mainly supportive and contains sodium restriction, diuresis, renal replacement therapy, analgesia and therapeutic paracentesis[ 73 ]. Sodium and water balance need to be managed by reducing both oral and intravenous sodium in patients with sinusoidal obstructive syndrome.…”

Oncological Nutrition

“…In addition to surgery, chemotherapy and radiation are common treatment modalities employed to eradicate the cancer. Ringo and Chen 24 share a case study regarding a patient who developed sinusoidal obstructive syndrome after an allogeneic bone marrow transplant. As the patient's clinical status deteriorated, practitioners caring for the patient encountered a variety of challenges with providing adequate nutrition support.…”