Parenteral nutrition in bone marrow transplantation

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

“…146,155,157,160,162,184 PN does not seem to decrease the incidence of GVHD in individuals undergoing HCT. 146,155 In fact, high dextrose (100% nonprotein calories) PN has been associated with an increased incidence of GVHD. 157 Incidence of GVHD appears to decrease with increased protein intake in patients consuming SOD 184 or EN.…”

“…The risks and benefits of using PN in HCT have been assessed comparing PN vs SOD [146][147][148][149] or EN [150][151][152] vs PN vs intravenous fluids (IVF) alone. [153][154][155] Studies of PN vs SOD or EN demonstrate increased morbidity, 146 more diarrhea, 150 more hyperglycemia, 151,152 and delayed time to engraftment 149,152 but less weight loss 146,147 and less loss of body fat 148 with PN. There appear to be no differences in incidence or severity of GVHD.…”

“…There appear to be no differences in incidence or severity of GVHD. 146 Comparison of PN to IVF [153][154][155] indicate earlier resumption of oral intake with IVF 153 but no difference in morbidity. 155 A study of children and adults reported a positive effect of PN on mortality compared to those who received IVF in patients who received allogeneic transplants, but not autologous transplants.…”

Clinical effect of individualized parenteral nutrition vs conventional method in patients undergoing autologous hematopoietic SCT

“…In contrast, some other studies found no beneficial effect of PN on the time to engraftment. 1,10,13,16,23 As an explanation for this difference, we can mention that in Weisdorf et al 22 and our study, PN provided B130% of BEE, according to the Harris À Benedict equation, while in the study by Lough et al…”

“…Based on the Szeluga study 10 when patients received 40 kcal/kg/day, their body weights increase by 18%, primarily as body fat but those receiving half the calories lose their Meanwhile, weight gain is nearly impossible in hematopoietic SCT patients due to synthesis of catabolic hormones secondary to hematopoietic SCT stress, so the major goals of PN are to minimize starvation effects during the course of transplantation, prevent specific nutrient deficiencies and improve immune and gut-barrier functions. 3,11,13,14 In our study, weight loss is acceptable and our PN method seems to be effective.…”