Five-Year Experience of Early Enteral Feeding in Patients Undergoing Allogeneic Stem Cell Transplantation Following Myeloablative Conditioning.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3004-3004
Author(s):  
David Seguy ◽  
Majd Ben Rejeb ◽  
Valerie Coiteux ◽  
Caroline Dendoncker ◽  
Helene Baudelle ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Median Duration ◽  
Enteral Feeding ◽  
Nutritional Support ◽  
Energy Requirement ◽  
Oral Intake ◽  
Oral Feeding ◽  
Second Period

Abstract Since the early 2003 with the encouraging preliminary results of our pivotal study (Seguy, transplantation), all pts refereed to our unit for myeloablative Allogenic Stem Cell Transplantation (allo-CST) were offered right away enteral feeding via a naso-gastric tube (NGT). The aim of this work was to investigate the evolution of our practices regarding nutritional support and its impact on early outcomes over the last five years. During a systematic individual pre-transplantation interview, all pts were provided with comprehensive information regarding NGT feeding. They received advice on an ongoing basis from a multidisciplinary team. Between Jan 01 and Dec 05, 121 pts who underwent myeloablative allo-SCT were offered EN. Among them, 94 (78%) agreed to receive EN (EN group) and 27 (22%) refused the NGT (without EN group: WEN group) and received either parenteral nutrition (PN) (n=22) or oral feeding only (n=5). The NGT was inserted shortly after transplantation. Bacteriological high-controlled oral diet intake was encouraged for as long as the patient was able to sustain it. The daily oral intake was scheduled to provide 100% of estimated requirements for energy (30–35 kcal/kg/day). Overnight NGT feeding, was gradually increased depending on the patient’s tolerance in order to reach 50–70% of energy requirement within 5 days. In case of intolerance toward EN, additional or total PN was given. In the WEN group, pts received PN when total oral intake was less than two-thirds of the average energy requirement over 5 days. Except for the pts’ age (EN-group, 38y vs WEN 28y, p=.038), the two groups were comparable in terms of initial pts’ characteristics and transplantation modalities. Median duration of EN was 14 days (1–59) and 61 pts received no additional PN while the median duration of the PN was 12 days (2–70). There was no significant difference between the two groups regarding duration of hospitalization, nutritional status at discharge and duration and grade of mucositis. Significant differences were observed, however: engraftment, 100% vs 93%, p=.05, duration of neutropenia, 20d (10–64) vs 25d (18–100), p=.0001 and thrombopenia 27d (6–100) vs 56d (50–100), p=.014; serum albumine level at discharge < 35g/L, 45% vs 76%, p=.005 for EN-group vs WEN-group, respectively. Pts with EN developed less often acute grade III/IV GVHD (9% vs 37%; p=0.001) and non-bacterial infections (9% vs 41%; p=.0002). In addition, pts with enteral feeding had better 100-day survival (92% vs. 67%, P=0.001) with less infection-related deaths. In multivariate analysis the absence of enteral nutrition was the only factor adversely influencing 100-day survival (CI 95%: 1.55–14.9 0.646; P=.007). In order to evaluate the practices over time regarding nutritional support in our unit, we compared the initial period (2001–02) when pts (n=41) had the choice between EN and PN with the second period (2003–05) when EN was offered systematically (n=80). In the second period, pts received less often PN (73% vs. 31%, p<.0001) and more often EN (49% vs. 93%, p<.0001) with longer duration (10d vs. 15d; p=.001). In addition, EN started earlier after transplantation (5d vs 2d, p=.004). CONCLUSION: EN has been well tolerated and dramatically reduced the proportion of pts requiring PN. This study confirms the positive impact of EN on early outcome of pts undergoing myeloablative allo-CST. When possible EN should be preferred to PN.

Effect of malnutrition-driven nutritional support protocol on clinical outcomes in autologous stem cell transplantation patients

2020 ◽  
Vol 29 (2) ◽  
pp. 997-1003
Author(s):  
Heather Lazarow ◽  
Ryan Singer ◽  
Charlene Compher ◽  
Cheryl Gilmar ◽  
Colleen R. Kucharczuk ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Clinical Outcomes ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Nutritional Support

scholarly journals Feasibility and safety of exercise training and nutritional support prior to haematopoietic stem cell transplantation in patients with haematologic malignancies

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Erik Rupnik ◽  
Matevz Skerget ◽  
Matjaz Sever ◽  
Irena Preloznik Zupan ◽  
Maja Ogrinec ◽  
...  
Keyword(s):  
Stem Cell ◽  
Exercise Training ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Physical Performance ◽  
Haematopoietic Stem Cell Transplantation ◽  
Nutritional Support ◽  
Haematopoietic Stem Cell ◽  
Strength Exercises ◽  
Haematologic Malignancies

Abstract Background Prehabilitation with regular exercise and nutritional care for patients undergoing surgeries for malignant disease was recently introduced to increase physiologic reserve prior to the procedure, accelerate recovery and improve outcomes. This study aimed to investigate the feasibility and safety of combined exercise training and nutritional support in patients with haematologic malignancies prior to haematopoietic stem cell transplantation (HSCT). Methods In this single-arm pilot study, 34 HSCT candidates were enrolled at least two weeks before admission for the procedure. Patients performed aerobic exercises at least 4 days per week for 20–30 min and strength exercises 3 days per week for 10–20 min. They received daily supplements of whey protein (0.3–0.4 g/kg body weight) and oral nutritional supplements if needed. The primary endpoints were feasibility (acceptability > 75%, attrition < 20%, adherence > 66%) and safety. The secondary endpoints were fat-free mass (FFM), muscle strength, physical performance and health-related quality of life (HRQoL) at HSCT. Results The rate of acceptability, attrition and adherence to aerobic exercise, strength exercise and protein supplement consumption was 82.4, 17.8, 71, 78 and 80%, respectively. No severe adverse events were reported. Twenty-eight patients participated in the study for a median of 6.0 weeks (range, 2–14). They performed aerobic exercises 4.5 days per week for 132 min per week and strength exercises 3.0 times per week. Patients consumed 20.7 g of extra protein daily. At the end of the programme, we recorded increases of 1.1 kg in FFM (p = 0.011), 50 m in walking distance in the 6-min walking test (6MWT) (p < 0.001), 3.3 repetitions in the 30-s chair-stand test (30sCST) score (p < 0.001) and 2.6 kg in handgrip strength (p = 0.006). The EORTC QLQ-C30 scores improved by 8.6 (p < 0.006) for global health status, 8.3 (p = 0.009) for emotional functioning, and 12.1 (p = 0.014) for social functioning. There was less fatigue, nausea and insomnia (p < 0.05). Conclusions Our study shows that a multimodal intervention programme with partially supervised exercise training combined with nutritional support prior to HSCT is feasible and safe. Patients showed improvements in FFM, physical performance and HRQoL. Additional research is needed to assess the possible positive effects of such interventions.

Usefulness of Recombinant Human Erythropoietin during Induction-Consolidation Chemotherapy for Chronic Hematological Lymphoid Malignancies: Improving Stem Cell Harvest and Reducing Blood-Product Support for Patients Receiving Autologous Stem-Cell Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5293-5293
Author(s):  
Fontanet D. Bijou ◽  
Reza Tabrizi ◽  
Thibaut Legay ◽  
Cyril Melot ◽  
Krimo Bouabdallah ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Median Duration ◽  
Transfusion Requirement ◽  
Median Number ◽  
Consolidation Chemotherapy ◽  
Duration Of Hospitalization ◽  
Cell Harvest

Abstract Many discrepancies remain on how to use the combination of G-CSF and Epo in patients (pts) with hematological malignancies. Some studies have shown efficacy of this combination in autologous stem cell transplantation (ASCT) when they are used throughout the procedure, while other have demonstrated no benefit when this combination is used after ASCT particularly for Epo. We reviewed retrospectively 30 pts (NHL= 6, HD= 2, MM= 22)who received ASCT for myeloma and lymphoma between September 2003 and May 2005. The main goal of this observation was to evaluate the impact of Epo combination (epoetin beta, alfa or darbepoetin) with G-CSF during chemotherapy administered before ASCT in order to achieve a better hemoglobin (Hb) level before the ASCT procedure. We also evaluated a possible efficacy of this combination upon hematopoietic recovery, transfusion support and stem cell harvest for this population of pts. We used G-CSF (5 μg/kg) alone after stem cell reinfusion in our therapeutic scheme. Patients characteristics were F/M 19/11; 6 pts were in complete response and 24 in partial response of their disease. Conditioning regimen preparations were standard with Melphalan at doses between 140–200 mg/m2 (22 pts), BEAM (7 pts), Cyclophosphamide and Total Body Irradiation (1 pt). After at least 12 weeks of treatment, median Hb level before ASCT was 11.6 g/dl (8.5–14.8) and epoetin beta was used in most patients. Median CD34 cells reinfused were 4.4 (1.2–13.7) with a median number of leukapheresis of 3 (2–9). Hematopoietic reconstitution was fast according to published data and local experience, with a median duration of neutropenia (absolute neutrophils count < 0.5 x 109/l) of 7 days (5–11); the median number of days with platelets counts < 20 x 109 /l and 50 x 109/l was 3 (0–14) and 7 (2–17) respectively. Median transfusion requirement was 1 red cells unit (0–6) and 2 platelets units (0–8) respectively. Median duration of hospitalization was 18 days (15–26). In conclusion, the use of combined G-CSF and Epo has probably improved clinical course of ASCT by reducing transfusion requirement, duration of hospitalization and neutropenia even when it is used before ASCT. Attempts have to be made to identify the place of Epo administration during ASCT procedure. Randomized prospective study might bring some important information about influence of this combination upon stem cell harvest particularly when it is used before the ASCT during induction and consolidation chemotherapy.

Norovirus Infections in Patients with Hematological Diseases and After Stem Cell Transplantation; Epidemiological and Clinical Aspects.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2661-2661
Author(s):  
Per T. Ljungman ◽  
Per Bernell ◽  
Richard Lerner ◽  
Jonas Mattsson ◽  
Maria Rotzén Östlund ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Median Duration ◽  
Stem Cell Transplant ◽  
Positive Sample ◽  
Clinical Aspects ◽  
Cell Transplant ◽  
Hematological Diseases ◽  
Virus Excretion

Abstract Abstract 2661 Poster Board II-637 Norovirus infections have become a major practical clinical problem during the last few years causing outbreaks in many different situations including in hospitals infecting both patients and staff. These infections have also been associated with prolonged virus excretion in renal transplant recipients and a risk of mortality in the elderly. Little is known about the clinical impact of norovirus infections on patients who are severely immunosuppressed. The aim of this study was to analyze the impact of norovirus infections in patients with hematological diseases and after hematopoietic stem cell transplantation (HSCT). The laboratory records from the Clinical Microbiological Laboratory at Karolinska University Hospital were examined in order to identify patients with proven norovirus infection hospitalized on the haematology or allogeneic stem cell transplant wards from 2006 to 2009. The diagnostic methodology was based on an accredited protocol including a reverse transcription real- time PCR procedure with the use of oligonucleotide primers specific for detection of norovirus genotype 1 or 2 in separate wells. After identification of cases, the patient charts were reviewed to assess outcome, possible norovirus associated clinical complications, and delay of antitumor therapy. The duration of virus excretion was defined as the time from the first to the last positive sample. 65 patients were identified. 19 patients had NHL, 14 AML, 8 multiple myeloma, 8 non-malignant hematological disorders, 5 ALL, 5 CLL, 4 MDS, and one patient had CML. 24 patients had undergone HSCT; 22 allogeneic and 2 autologous. The median age was 63.1 (1.1–84.2). The cases occurred in two major and 3 minor clusters over the 3 year period with some additional sporadic cases occurring between the clusters. One of the haematology wards had to be closed for admission twice and one ward once since also several cases occurred among the staff. 17 of the detected viruses were typed to genogroup 2, 2 to genogroup 1, and 46 were not typed. 29 patients had only one positive sample of which 11 had a negative follow-up sample. The median duration of viral detection in the entire cohort was 2 days (1–216 days). Among the patients with more than one positive sample, the median duration was 15 days (2–216 days). 25/65 (38%) patients were PCR positive more than one week, 18 (28%) for more than two weeks, and 9 (14%) for more than four weeks. The majority of patients had minor and quickly resolved gastrointestinal symptoms. Five patients died in close temporal association with the norovirus infection (within a week). Three patients had fluid balance and electrolyte abnormalities and in of these a pre-existing renal failure worsened and the patient required dialysis. One patient died from pneumonia and one patient died from multiple causes with an end-stage malignancy. Seven patients (11%) had planned cytotoxic chemotherapy postponed; one of these patients had a delay in a planned allogeneic HSCT. We conclude that norovirus infection is a significant clinical complication to management of patients with hematological malignancies and stem cell transplant patients. Fatal outcome is possible primarily in patients with severe underlying conditions. Delay in planned chemotherapy was common and in addition the required closing of the ward presumably delaying chemotherapy for other non-infected patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Efficacy and Cost-Effectiveness of a Different Schedule for the Prevention of Fungal Infections during the Early Phase of Stem Cell Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1154-1154
Author(s):  
Lucrecia Yáñez ◽  
Noemí Fernández ◽  
Arancha Bermudez ◽  
Germán Pérez ◽  
Andres Insunza ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Fungal Infection ◽  
Cell Transplantation ◽  
Median Duration ◽  
Early Phase ◽  
Fungal Infections ◽  
Conditioning Regimen ◽  
Antifungal Treatment ◽  
Water Filters

Abstract Introduction: The first 30 days (early phase) following stem cell transplantation (SCT), especially in the allogeneic setting, are considered at risk for fungal infections. Antifungal prophylaxis with extended spectrum azole or echinocandins is highly recommended, however they are associated with adverse events, drug interactions or high prices. In our center, except for those patients who need secondary fungal prophylaxis, we use environmental protection (HEPA air and water filters) and we only start antifungal treatment (fluconazole or echinocandin) at the first peak of fever during the neutropenic phase of autologous (auto-SCT) or allogeneic (allo-SCT) transplant. Objective: The aim of this unique-center retrospective study is to evaluate the incidence of fungal infections during the early phase and compare the real cost of our procedure with the hypothetical cost if we would have used the standard practice: posaconazole (200 mg/8h oral suspension), voriconazole (200 mg/12h intravenous) or micafungin (100 mg/24h intravenous), started at the beginning of conditioning or started the day of transplant. Patients and methods: Two hundred and eighty-one patients were evaluated, 188 allo-SCT (102 unrelated donor) and 93 auto-SCT. Median age at allo and auto-SCT was 49 years and 56 years respectively. The main underlying disease and conditioning regimen were acute leukemia (90) and fludarabine based combinations (142) respectively. To assess the efficacy, we evaluated the development of probable or proven fungal infection according with the EORTC-2008 criteria during neutropenia and the two weeks following neutrophil recovery, the type of microorganism, fungal infection as the cause of death and autopsy diagnosis if the patient died during the first 60 days after stem cell infusion. We compared the efficacy, with that reported in the literature. To assess the cost of our procedure (Group V1), we evaluated the days on the protected environment room, the days of hospitalization and the type and days of antifungal treatment. The hypothetical cost of the standard prophylaxis was calculated in each patient based on the beginning of the conditioning regimen (Groups CPos, CVor, CMic) or the day of infusion (Groups TPos, TVor and TMic) to outpatient. Cost per day of HEPA and water filters was 4.28 $. Drug costs were calculated based on our local prices. Differences between costs of the groups were calculated with the paired two-sample t-test. Results: Two proven (C.parapsilosis and Alternaria sp.) and 3 probable (2 Aspergillus and 1 Mucor) fungal infections were diagnosed during the early phase (incidence 1.67%). At day +60, 16 patients had died, 2 of them because of fungal infection (1 Aspergillus and 1 Mucor). Another fungal infection was detected in 1 of the 8 autopsies made (Cumulative incidence 2.13%). Median duration of conditioning regimen and hospitalization was 6 days and 26 days respectively. Median duration of isolation in the environmental protected room was 24 days. Forty patients (14.2%) did not need antibiotic treatment. The majority of patients were treated only with fluconazole (65) for a median of 7 days, only with an echinocandin (48) for a median of 13 days, or with fluconazole for a median of 5 days followed by echinocandin during 7 days in 53 patients. The mean cost per patient of Group V1 was 2702 $, statistically different (p <0.001) when it was compared with Groups CVor (8896 $), TVor (7026 $), CMic (12261 $) and TMic (9671 $). However, we did not find differences in costs when the Group V1 was compared with posaconazole (CPos 3051 $ and TPos 2422 $, p=0.162 and p=0.268 respectively). Conclusions: We present a different schedule for the prevention of fungal infection during the neutropenic period of SCT with the same efficacy as reported by Cornely (2007), Wingard (2010), Van Burik (2004), and lower cost than voriconazole or micafungin in primary prohylaxis. Although we did not observe differences in cost with the posaconazole group, we did not include in the analysis several factors (mucositis, hepatic impairment, fungal suspicion) that can modify its continued use. Disclosures Yáñez: Gilead: Consultancy, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Astellas: Consultancy; MSD: Consultancy, Speakers Bureau.

scholarly journals Parenteral nutritional support in children in the early period after hematopoietic stem cell transplantation: specifics and clinical aspects

2021 ◽  
Vol 20 (4) ◽  
pp. 199-208
Author(s):  
A. Yu. Vashura ◽  
Yu. A. Alymova
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Parenteral Nutrition ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Nutritional Support ◽  
Clinical Aspects ◽  
Hematopoietic Stem ◽  
Gastrointestinal Complications

Hematopoietic stem cell transplantation (HSCT) as a treatment modality is associated with nutritional problems that are mainly caused by eating difficulties and gastrointestinal complications occurring at different stages of HSCT: starting from conditioning until late post-transplant period. Nutritional problems have in turn a negative impact on the outcomes of HSCT which demonstrates the importance of preventive measures and timely correction of these problems. The majority of patients who underwent HSCT experience various problems at different stages of treatment leading to a situation when enteral nutrition is impossible. This is why parenteral nutrition is of utmost importance in these patients. This review describes the main clinical factors that may influence the prescription of nutritional support to patients after HSCT as well as possible problems and negative consequences of inappropriate prescribing of parenteral nutrition. 

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