BACKGROUND: Parenteral nutrition (PN) is still widely preferred to enteral nutrition (EN) in malnourished patients undergoing allogeneic stem-cell transplantation (allo-SCT) after myeloablative conditioning (MAC). The purpose was to determine whether EN improves early outcome after MAC allo-SCT. METHODS: Early outcome was prospectively assessed in patients undergoing MAC allo-SCT. A total of 121 consecutive patients undergoing a first MAC allo-SCT for acute leukemia, myelodysplastic syndrome, or myeloproliferative syndrome were included. Patients who received cord blood were excluded. Enteral nutrition was systematically offered, although PN was provided when EN had been refused or was poorly tolerated. Among the patients, 94 received EN (EN group) and 27 did not (non-EN group). Overall survival (OS), cumulative incidence of engraftment and acute graft-versus-host disease (aGVHD) within the first 100 days after transplantation were studied. Because EN and PN treatment assignments were not random, propensity score adjustments were performed on patient outcomes. RESULTS: Outcome was better in the EN group than in the non-EN group for OS (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.04-0.42; P=0.0008), neutrophil (HR, 2.07; 95% CI, 1.26-3.39; P=0.004), and platelet (HR, 1.93; 95% CI, 1.004-3.70; P=0.049) engraftments and aGVHD development (HR, 0.12; 95% CI, 0.04-0.39; P=0.0004). In Cox model analysis, EN demonstrated a protective effect (HR, 0.20; 95% CI, 0.05-0.77; P=0.019) on OS, whereas demonstrated a detrimental impact (HR, 4.18; 95% CI, 1.02-17.12; P=0.047). Enteral nutrition was found to be an independent factor in neutrophil engraftment (HR, 2.17; 95% CI, 1.24-3.81; P=0.007), whereas PN delayed platelet engraftment (HR, 0.57; 95% CI, 0.33-0.99; P=0.046). Enteral nutrition was the only factor that was protective against grades 3 to 4 aGVHD development (HR, 0.19; 95% CI, 0.05-0.72; P=0.01). CONCLUSIONS: Routine use of EN is preferable to upfront PN in these patients.
BACKGROUND: Parenteral nutrition (PN) is still widely preferred to enteral nutrition (EN) in malnourished patients undergoing allogeneic stem-cell transplantation (allo-SCT) after myeloablative conditioning (MAC). The purpose was to determine whether EN improves early outcome after MAC allo-SCT. METHODS: Early outcome was prospectively assessed in patients undergoing MAC allo-SCT. A total of 121 consecutive patients undergoing a first MAC allo-SCT for acute leukemia, myelodysplastic syndrome, or myeloproliferative syndrome were included. Patients who received cord blood were excluded. Enteral nutrition was systematically offered, although PN was provided when EN had been refused or was poorly tolerated. Among the patients, 94 received EN (EN group) and 27 did not (non-EN group). Overall survival (OS), cumulative incidence of engraftment and acute graft-versus-host disease (aGVHD) within the first 100 days after transplantation were studied. Because EN and PN treatment assignments were not random, propensity score adjustments were performed on patient outcomes. RESULTS: Outcome was better in the EN group than in the non-EN group for OS (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.04-0.42; P=0.0008), neutrophil (HR, 2.07; 95% CI, 1.26-3.39; P=0.004), and platelet (HR, 1.93; 95% CI, 1.004-3.70; P=0.049) engraftments and aGVHD development (HR, 0.12; 95% CI, 0.04-0.39; P=0.0004). In Cox model analysis, EN demonstrated a protective effect (HR, 0.20; 95% CI, 0.05-0.77; P=0.019) on OS, whereas demonstrated a detrimental impact (HR, 4.18; 95% CI, 1.02-17.12; P=0.047). Enteral nutrition was found to be an independent factor in neutrophil engraftment (HR, 2.17; 95% CI, 1.24-3.81; P=0.007), whereas PN delayed platelet engraftment (HR, 0.57; 95% CI, 0.33-0.99; P=0.046). Enteral nutrition was the only factor that was protective against grades 3 to 4 aGVHD development (HR, 0.19; 95% CI, 0.05-0.72; P=0.01). CONCLUSIONS: Routine use of EN is preferable to upfront PN in these patients.
Authors: A Baumgartner; A Bargetzi; N Zueger; M Bargetzi; M Medinger; L Bounoure; F Gomes; Z Stanga; B Mueller; P Schuetz Journal: Bone Marrow Transplant Date: 2017-01-09 Impact factor: 5.483
Authors: Tiago Nava; Marc Ansari; Jean-Hugues Dalle; Christina Diaz de Heredia; Tayfun Güngör; Eugenia Trigoso; Ulrike Falkenberg; Alice Bertaina; Brenda Gibson; Andrea Jarisch; Adriana Balduzzi; Halvard Boenig; Gergely Krivan; Kim Vettenranta; Toni Matic; Jochen Buechner; Krzysztof Kalwak; Anita Lawitschka; Akif Yesilipek; Giovanna Lucchini; Christina Peters; Dominik Turkiewicz; Riitta Niinimäki; Tamara Diesch; Thomas Lehrnbecher; Petr Sedlacek; Daphna Hutt; Arnaud Dalissier; Jacek Wachowiak; Isaac Yaniv; Jerry Stein; Koray Yalçin; Luisa Sisinni; Marco Deiana; Marianne Ifversen; Michaela Kuhlen; Roland Meisel; Shahrzad Bakhtiar; Simone Cesaro; Andre Willasch; Selim Corbacioglu; Peter Bader Journal: Bone Marrow Transplant Date: 2020-02-06 Impact factor: 5.483
Authors: Tessa M Andermann; Jonathan U Peled; Christine Ho; Pavan Reddy; Marcie Riches; Rainer Storb; Takanori Teshima; Marcel R M van den Brink; Amin Alousi; Sophia Balderman; Patrizia Chiusolo; William B Clark; Ernst Holler; Alan Howard; Leslie S Kean; Andrew Y Koh; Philip L McCarthy; John M McCarty; Mohamad Mohty; Ryotaro Nakamura; Katy Rezvani; Brahm H Segal; Bronwen E Shaw; Elizabeth J Shpall; Anthony D Sung; Daniela Weber; Jennifer Whangbo; John R Wingard; William A Wood; Miguel-Angel Perales; Robert R Jenq; Ami S Bhatt Journal: Biol Blood Marrow Transplant Date: 2018-02-19 Impact factor: 5.742