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Clinical impact of systematic nutritional care in adults submitted to allogeneic hematopoietic stem cell transplantation
Rev Bras Hematol Hemoter. 2012;34(5):334-8
Table 4 - Comparison between main outcomes by group (Non-intervention vs. Intervention Group): graft type, and conditioning regimen
Non-intervention Group
Intervention Group
Graft type
Conditioning regimen
Graft type
Conditioning regimen
Related donor
n = 57
Myeloablative
n = 42
Nonablative
n = 15
Related donor
n = 25
Unrelated
donor
n = 9
Myeloablative
n = 28
Nonablative
n = 6
Hospital stay (days) - median (range)
43 (15-101)
43 (15-93)
41 (28-101)
41 (23-89)
48 (24-117) 42.5 (23-117)
36 (24-78)
Infections - n (%)
39 (68.4)
25 (59.5)
14 (93.3)
17 (68)
5 (55.5)
18 (64.3)
4 (6.66)
In-hospital deaths - n (%)
9 (15.8)
9 (15.8)
0
5 (20)
5 (55.5)
7 (25)
1 (16.6)
Death at 6 months - n (%)
14 (24.6)
12 (28.6)
2 (13.3)
8 (32)
3 (33.3)
10 (35.7)
1 (16.6)
Death at 12 months - n (%)
29 (50.9)
22 (52.4)
7 (4.6)
7 (28)
3 (33.3)
10 (35.7)
0
Number post-HSCT admissions -
median (range)
2 (0-16)
2 (0-16)
2 (0-15)
3 (1-14)
7 (0-14)
5 (1-14)
2.5 (0-12)
Chronic GVHD - n (%)
None
34 (59.65)
29 (69)
5 (33.3)
20 (80)
9 (100)
24 (85.7)
5 (83.3)
Limited
13 (22.8)
8 (19)
5 (33.3)
4 (16)
0
4 (14.3)
0
Extensive
10 (17.5)
5 (11.9)
5 (33.3)
1 (4)
0
0
1 (16.6)
Acute GVHD - n (%)
Grade I/II
14 (24.6)
8 (19)
6 (40)
9 (36)
3 (33.3)
10 (35.7)
2 (33.3)
Grade III/IV
10 (17.5)
7 (16.6)
3 (20)
3 (12)
1 (11.1)
3 (10.7)
1 (16.6)
CMV - n (%)
10 (17.5)
8 (19)
2 (13.3)
7 (28)
4 (44.4)
8 (28.6)
3 (50)
In-hospital weight loss > 10% - n (%)
22 (38.6)
14 (33.3)
8 (53.3)
10 (40)
5 (55.5)
12 42.8)
3 (50)
Neutropenia – n (%)
55 (96.5)
41 (97.6)
14 (93.3)
20 (80)
8 (88.8)
22 (78.5)
6 (100)
HSCT: Hematopoietic stem cell transplantation; GVHD: Graft versus host disease; CMV: Cytomegalovirus
PN was prescribed to 30 (52.6%) patients in the NIG and 20
patients (58.8%) in the IG. The duration of PN, mean PN calorie
intake and mean oral calorie intake are shown in Table 3.
There were no significant differences between related-donor
and unrelated-donor graft recipients with respect to any of the
outcomes of interest (Table 4).
There were no significant differences between groups in
length of hospital stay, prolonged hospitalization rate, presence
and severity of GVHD, infection rate, or duration of neutropenia.
There were no significant differences between groups in in-
hospital death or post-transplant mortality at 6 months or 12 months.
Discussion
Nutritional and clinical assessment revealed no significant
differences between groups for any of the variables of interest,
confirming the similarity in nutritional and clinical profile of the
study sample prior to the intervention.
Less PN was given to patients in the IG than those in the
NIG; however, as both groups were similar at the time of HSCT,
this means that prescription of PN was optimized in the IG. This
rationalization of management after the implementation of a
nutritional care protocol will certainly have reduced hospital costs.
There were no significant differences in the post-HSCT
complication rates, infection rates or lengths of hospital stay. This
may be explained by the fact that length of stay is determined by the
duration of treatment itself, that the mortality rate may have been the
same due to universally adequate treatment and that PN-associated
infection rates are mostly determined by care in compounding
(22).
In the present study, 52% of patients in the NIG and 58%
of those in the IG received PN. This is within the range reported
in the literature, where the percentage of HSCT patients given
PN ranges from 37% in autologous graft recipients to 91% in
unrelated-donor allogeneic graft recipients
(16)
.
Table 3 - Comparison between duration of parenteral nutrition and mean caloric intake in the Non-intervention and Intervention Groups
Non-intervention Group
Intervention Group
Graft type
Conditioning regimen
Graft type
Conditioning regimen
Related donor
n = 57 (100%)
Myeloablative n
= 42 (73.7%)
Nonablative
n = 15 (26.3%)
Related donor
n = 25 (73.5%)
Unrelated
donor
n = 9 (26.5%)
Myeloablative
n = 28 (82.3%)
Nonablative
n = 6 (17.7%)
Patients receiving PN -
n (%)
30 (52.6)
26 (61.9)
4 (26.6)
14 (56)
6 (66.6)
20 (71.4)
0
Duration of PN (days) -
median (range)
20.5 (4–73)
20.5 (4–73)
18.5 (11–59)
6.5 (1–28)
11 (1–21)
7 (1–28)
0
Daily PN calorie intake (kcal) -
Mean ± SD
1554 ± 309
1600 ± 259
1395 ± 425
1516 ±250
1343 ± 462 1480 ± 299
0
Mean daily oral intake during oral
feeding (kcal) - Mean ± SD
1310 ± 465
1288 ± 446
1366 ± 525
1642 ± 586 1646 ± 598 1609 ± 616
1801 ± 366
PN: parenteral nutrition; SD; Standard deviation