Pre-transplant arm muscle area: a simple measure to identify patients at risk

Thomaz, Ana Cláudia; Silvério, Carolline Ilha; Campos, Denise Johnsson; Kieuteka, Elena Emilia Moreira; Rabito, Estela Iraci; Funke, Vaneuza Araújo Moreira; Vilela, Regina Maria

doi:10.1007/s00520-015-2850-2

Cited by 18 publications

(15 citation statements)

References 27 publications

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“…2 Regarding BMI, our data showed few malnourished patients in pre-transplantation, as in other studies. 23 Although some studies have shown a positive association between BMI and overall survival, we did not nd such an association. BMI alone does not properly evaluate lean mass and fat mass changes and does not re ect patients' body composition, which helps to explain con icting literature results for HSCT outcomes in the elderly when only BMI or is considered.…”

Section: Discussioncontrasting

confidence: 71%

“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older Adults Undergoing Hematopoietic Stem Cell Transplantation”

Koch¹,

Pereira²,

Hamerschlak³

et al. 2021

Preprint

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Aim: The incidence of most hematologic malignancies increases with age. Hematopoietic stem cell transplantation (HSCT) provides a potentially life-prolonging or curative option for many patients in this scenario. Limited data is available on muscle mass and density assessed from CT-images on outcomes after HSCT. We aimed to evaluate the influence of body composition on morbidity and mortality in older adults undergoing (HSCT). Methods: Retrospective longitudinal study conducted with 50 patients ≥ 60 years undergoing HSCT at Hospital Israelita Albert Einstein, São Paulo. Body composition was assessed by chest computed tomography and treatment related mortality, graft versus host disease, neutrophil grafting, and overall survival were analyzed.Results: 148 HSCT patients were evaluated, 50 patients were eligible: 60% with autologous and 40% with allogeneic transplantation. Body mass index in patients was (female: 26.9 ± 4.7 kg/m2; 30.1± 4.9 kg/m2) - autologous and (female: 24.3 ± 5.15 kg/m2; male: 26.4 ± 2.0 kg/m2) - allogeneic. In autologous transplant group, we found a positive association between age and death risk with an increase of 63.5% in this risk (p=0.006) and also Karnofsky performance scale with decrease of 11.9% in death risk (p<0.001). A negative association between muscle radiodensity and death risk was observed in allogeneic transplantation patients with risk decrease of 20.1% (p = 0.032). We found a positive association between T4 muscle area and radiodensity with risk of acute graft versus host disease (p= 0.028). Conclusion: In population studied, body composition assessed by chest tomography showed the importance of radiodensity for better prognosis.

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Section: Discussioncontrasting

confidence: 71%

“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older Adults Undergoing Hematopoietic Stem Cell Transplantation”

Koch¹,

Pereira²,

Hamerschlak³

et al. 2021

Preprint

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“…On commencement of treatment, regardless of nutrition support route or anthropometric measure, most children maintained a satisfactory nutritional status either during nutrition support (37), or until discharge (19,38,40). Although weight and BMI were widely used, they are crude markers of nutritional status and do not provide details of body composition which is an important consideration for survival (45). Future studies should consider using MUAC or bioelectrical impedance as more sensitive markers of nutritional status (46).…”

Section: Discussionmentioning

confidence: 99%

Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Evans

Hirani

Needle

2019

Biology of Blood and Marrow Transplantation

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Background: Hematopoietic stem cell transplantation (HSCT) involves the administration of chemotherapy followed by the infusion of donor stem cells. After treatment, children can consequently experience nausea, vomiting, diarrhea, anorexia and mucositis, which negatively impact oral intake leading to rapid deterioration in nutritional status and risk of malnutrition. Nutrition support therefore becomes necessary to circumvent these adverse effects. This has traditionally been provided via parenteral nutrition (PN), but pediatric evidence is increasingly advocating enteral nutrition (EN) as a preferential alternative. The objective of this review is to determine the efficacy of any forms of EN vs. PN provided during admission to children ≤18 years undergoing HSCT. Primary outcomes considered efficacy in relation to various nutritional parameters, and secondary outcomes included a range of posttransplantation parameters. Methods: Data sources included English and non-English articles from the start date of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Controlled Trials register, up to July 2018. Key journals were also hand searched, reference lists scanned, clinical experts contacted and grey literature searched using EThOS and Open Grey. Randomized and observational studies comparing any forms of EN vs.PN in children ≤18 years undergoing HSCT investigating nutritional or post-transplantation outcomes were eligible. Data were extracted from included studies using a custom extraction form that had previously been piloted. As included studies were observational, risk of bias was assessed using ROBINS-I. Results:As only a small number of heterogenous studies reporting a wide range of differently defined outcomes were included, meta-analyses were not performed and data were presented in narrative form.Conflicting results in favor of either method of nutrition support, or no difference between methods, were seen for duration of interventions, nutritional intakes, biochemical and anthropometric changes, mortality, infections, length of admission and neutrophil engraftment. EN may provide favorable benefits over PN regarding acute graft-versus-host-disease (aGvHD) and platelet engraftment. Discussion:A paucity of studies were found investigating the question posed by this review. Included studies were clinically heterogenous regarding populations, interventions and outcomes, at moderate to serious risk of bias due to the absence of randomization, confounding parameters, statistical control, retrospective designs and participant selection. Some studies were more than 15 years old.Conclusions: Despite the limited number and poor quality of identified studies, results support the growing body of pediatric evidence that EN is feasible during HSCT. Similar differences regarding many nutritional and post-transplantation outcomes were seen in both forms of nutrition support, but EN could provide benefits above PN including reduced incidence of aGvHD and faster platelet engraftment.

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“…[31][32][33] Both parameters lack information on body composition, which is considered to be of importance for survival. 34 Owing to conflicting data, there is still no consensus on which parameters best determine malnutrition, show a correlation with clinical outcomes and are reproduceable as well as easy to use in clinical practice. 3,8,35 Along with body composition, there is increasing interest in the effect of exercise on maintenance of muscle mass and survival.…”

Section: Discussionmentioning

confidence: 99%

Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review

Baumgartner

Bargetzi

Zueger

et al. 2017

Bone Marrow Transplant

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In 2009, the American Society of Parenteral and Enteral Nutrition and its European counterpart (Euopean Society for Parenteral and Enteral Nutrition) published guidelines regarding nutritional support of patients with hematologic stem cell transplantation. Our aim was to do an up-to-date literature review regarding benefit of nutritional interventions and treatment recommendations. We searched MEDLINE, EMBASE and Cochrane Library for interventional and observational clinical studies. We extracted data based on a predefined case report form and assessed bias. Out of 459 potential abstracts, 13 studies of mostly moderate quality with a total of 18 167 patients were included. Two very large trials reported negative associations of malnutrition and survival, transplant-related mortality and relapse risk. Some trials found enteral nutrition (EN) to be as effective as parenteral nutrition (PN) with lower complication rates. In addition, EN was associated with better survival, less acute GvHD and faster neutrophil recovery. A neutropenic diet was not superior regarding overall survival, but in contrast resulted in higher infection risk. Current moderate quality studies show negative associations of malnutrition and clinical outcomes, with EN being superior to PN. There was no benefit of neutropenic diets. Large, randomized controlled studies are needed to better understand optimal nutritional support in this patient population.

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Pre-transplant arm muscle area: a simple measure to identify patients at risk

Abstract: The AMA measured pre-HSCT showed to be a potential predictor of acute GVHD and mortality up to 180 days after transplant in adult patients.

Cited by 18 publications

References 27 publications

“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older Adults Undergoing Hematopoietic Stem Cell Transplantation”

“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older Adults Undergoing Hematopoietic Stem Cell Transplantation”

Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review

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Pre-transplant arm muscle area: a simple measure to identify patients at risk

Abstract: The AMA measured pre-HSCT showed to be a potential predictor of acute GVHD and mortality up to 180 days after transplant in adult patients.

Cited by 18 publications

References 27 publications

“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older&nbsp;Adults Undergoing&nbsp;Hematopoietic Stem Cell Transplantation”

“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older&nbsp;Adults Undergoing&nbsp;Hematopoietic Stem Cell Transplantation”

Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review

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“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older Adults Undergoing Hematopoietic Stem Cell Transplantation”

“Influence of Body Composition Assessed by Computed Tomography on Mortality in Older Adults Undergoing Hematopoietic Stem Cell Transplantation”