Prise en charge nutritionnelle des patients hospitalisés pour allogreffe de CSH : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC)

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults

“…(26) In a stage of protein-calorie malnutrition, involuntary weight loss and decreased levels of plasma proteins, such as albumin, there is a high risk of toxicity from chemotherapy and the other drug classes administered. (30) Albumin is the most abundant protein in human plasma, and it has multiple roles in body homeostasis, and an essential role as a drug-transport protein. This may have pharmacokinetic implications on clinical therapy, affecting plasma concentrations of chemotherapeutic agents.…”

“…(33) Another major downside of an impaired nutritional status in patients undergoing HSCT is the longer period of aplasia during the transplant, in which low BMI, hypoalbuminemia, and increased urinary nitrogen excretion are associated with a longer time to neutrophil engraftment, leading to increased susceptibility to infections, (34) in addition to financial losses, since these patients usually require prolonged hospitalization. (30) In addition to the anticipated harm, protein-calorie malnutrition and low oral intake are associated with increased GVHD rates (35) − particularly of the lungs, gastrointestinal tract and oral cavity. Vitamins A and D deficiency is also associated with higher incidence and severity of GVHD.…”

“…The healthcare team, the patient and family members must be approached about the possibility of EN indication at the pre-HSCT assessment, when questions and myths about NT should be clarified, and benefits explained. (30,242) The healthcare team must be encouraged to use EN as something beneficial to the treatment and the patient, and understand that NT in HSCT must be focused on preventing (72,275) deterioration of the nutritional status and nutritionrelated risks to patients.…”

“…The use of polymeric, high-calorie, highprotein EN is advocated. (30,40,246) Continuous infusion is recommended, with the use of a pump for better control of the diet. It is fundamental that the team establish the criteria for fulfillment of patients' nutritional needs in the shortest time possible.…”

“…It is fundamental that the team establish the criteria for fulfillment of patients' nutritional needs in the shortest time possible. (276) To complement oral nutrition, Bay et al, (30) recommended nocturnal EN infusion, with a 10-hour infusion duration, starting with 20mL per hour and progressing to 10mL to 20mL per night, aiming to administer 1,000 to 1,500kcal per day. (30) Enteral nutrition monitoring must occur to ensure patient tolerability of the therapy initiated, metabolic balance, and toxicity detection.…”