Malnutrition in patients with chronic GVHD

Abstract

Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had long-standing, moderate or severe cGVHD and had failed many lines of therapy. Twenty-nine percent (60/210) of subjects were malnourished, using the subjective Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and evaluation. No demographic or transplant characteristics were associated with malnutrition; cGVHD of the lungs, gastrointestinal (GI) tract and mouth, NIH global score, cGVHD symptoms, worse functioning, low albumin, poorer survival and low BMI were associated with malnutrition. A predictive model was developed from all variables of significance: cGVHD of the lungs, GI tract, mouth and BMI accurately predicted 84.2% of malnourished patients as well as 87.2% of well-nourished patients. The PG-SGA questionnaire may be a useful tool in diagnosing nutritional deficits in cGVHD patients undergoing one-time evaluations. Longitudinal prospective studies should assess the utility of nutritional support interventions in cGVHD.

Trial registration: ClinicalTrials.gov NCT00331968.

Figure 1

Malnutrition in cGVHD. The prevalence of malnutrition in cGVHD, as defined by PG-SGA questionnaire and BMI (a). Mean BMI is lower in the malnourished group than in the well-nourished group as defined by PG-SGA; however, substantial overlap of BMIs between groups suggests that the two measures are non-synonymous (b).

Figure 2

Survival analysis for malnutrition in cGVHD. Malnourished patients have poorer survival compared with well-nourished patients (log-rank, P = 0.005), in univariate analysis. In multivariable analysis, after adjusting for factors associated with survival in this cohort on previous analysis (NIH lung score, Karnofsky score, lymphocyte count, BSA erythema), this association was lost.