The Efficacy of an Oral Elemental Diet in Patients Undergoing Hematopoietic Stem Cell Transplantation

Abstract

Objective Conditioning regimens for hematopoietic stem cell transplantation (HSCT) are well known to cause severe gastrointestinal toxicities that often disturb the oral intake of the patients followed by poor nutrition and life-threatening infection. An oral elemental diet (ED) is an easily consumed and assimilated form of liquid nutrients mainly composed of amino acids. It alleviates the digestive loading from the intestine and is mainly used for enteral nutritional support in patients with Crohn's disease. We herein report, for the first time, the efficacy of ED for patients undergoing HSCT. Methods We evaluated the efficacy of ED in a prospective cohort study. The primary endpoint for this study was the hospitalization period. The secondary endpoint was the occurrence of oral mucositis, nausea, diarrhea and fever. Patients A total of 73 patients were consecutively enrolled between March 2011 and March 2013. Twenty-three patients underwent autologous HSCT and 50 patients underwent allogeneic HSCT. The first 21 patients did not receive ED (non-ED group; NEG) while in the successive 52 patients (ED group; EG), oral ED was started before conditioning and was continued until 28 days after transplantation. Results The patient characteristics were similar between the two groups. The mean duration of ED administration for EG was 28.7 days (range, 3-37 days), and the mean total-dose of ED administration was 1904 g (range, 240-2,960 g). The median hospitalization period was significantly shorter in EG compared to NEG, (34 days vs. 50 days; p=0.007). Grade 3-4 oral mucositis occurred less in EG than NEG (25% vs. 48%; p=0.06). Conclusion Oral ED may promote an early mucosal recovery and thereby shorten the duration of hospitalization.

Oligomeric Enteral Nutrition in Undernutrition, due to Oncology Treatment-Related Diarrhea. Systematic Review and Proposal of An Algorithm of Action

“…Further details about the literature search process are provided in Figure 1. Relevant studies were identified [52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68], and their results are summarized in Table 2 and Table 3.…”

“…Regarding chemotherapy-induced intestinal mucositis [60,61,62,63,64,65,66,67,68] (Table 3), all the studies we have found used the same oligomeric formula of enteral nutrition (Elental ® ). In total there are 345 patients, of whom 203 were treated with this oligomeric enteral nutrition, and the rest are controls without enteral nutrition.…”

“…In summary, the main objective of the studies is the effect of this type of oral nutritional supplement on oral mucositis in patients with chemotherapy. In all of the studies [60,61,62,63,64,65,66,67,68] oral mucositis improves, while the rest of the outcomes show different results. Only one study observes improvement in controls on body weight [68], while two others do not find differences [64,67], although in another they find improvement in lean body mass [60].…”

“…Only one study observes improvement in controls on body weight [68], while two others do not find differences [64,67], although in another they find improvement in lean body mass [60]. With regards to the response of diarrhea to this supplementation, the majority of studies do not find differences compared to the control group [62,65,66,68]. Despite these poor results, some authors note that hospitalization time decreases [62], and there are fewer cases in which chemotherapy should be stopped due to its side effects [64,67].…”

Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines—part 1: vitamins, minerals, and nutritional supplements

“…The use of an ED for the prevention of OM in patients undergoing HSCT was assessed in a single cohort study [58] and found to be ineffective. Therefore, no guideline was possible.…”