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Meta-Analysis
. 2021 Jan 6:11:535890.
doi: 10.3389/fimmu.2020.535890. eCollection 2020.

A Systematic Review of the Literature and Perspectives on the Role of Biomarkers in the Management of Malnutrition After Allogeneic Hematopoietic Stem Cell Transplantation

Enrico Morello  1 , Milena Giovanna Guarinoni  2 , Francesco Arena  1 , Marco Andreoli  3 , Simona Bernardi  1 , Michele Malagola  1 , Alessandro Turra  1 , Nicola Polverelli  1 , Domenico Russo  1
Affiliations
Meta-Analysis

A Systematic Review of the Literature and Perspectives on the Role of Biomarkers in the Management of Malnutrition After Allogeneic Hematopoietic Stem Cell Transplantation

Enrico Morello et al. Front Immunol. .

Abstract

Malnutrition is a common problem after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and could impair immune function. Immune dysfunction after allo-HSCT may be linked with infections, GVHD, and relapse and negatively affect the outcome. Aim of this review was to identify malnutrition biomarkers, potentially useful for immune-system monitoring, in the setting of allo-HSCT. After a systematic search, no satisfying biomarker was found, except for citrulline. Citrulline could be useful in monitoring gastrointestinal function after allo-HSCT and its role in the complex relationship with immune-system function ought to be better explored. A multi-omics approach, including biomarkers and PRO (patient reported outcomes) is, in our opinion, the optimal way to study the relationship between malnutrition and transplant outcomes.

Keywords: biomarker; citrulline; graft versus host disease; insulin growth factor-1 (IGF-1); malnutrition (MeSH).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of included studies.
Figure 2
Figure 2
Shows the three steps for nutritional assessment in bone marrow transplantation. First step includes an objective evaluation of anthropometric aspects. The second step involves an investigation on nutritional biomarkers. The third step includes tools that allow to standardize nutritional assessment. Thanks to these three steps, it is possible to make a nutritional diagnosis and start an earlier and personalized nutritional support.
Figure 3
Figure 3
Shows the possible role of IGF-1 in the development of acute GVHD and the possible role of citrulline in demonstrating the presence of mucosal damage. The conditioning regimen causes a mucosal and gut barrier damage. Gut toxicity has a huge impact on nutritional status. Mucosal and gut barrier damage could be evaluated by plasma citrulline levels: a biomarker of gut barrier damage. Insulin-like growth factor-1 (IGF-1) is the major mediator of growth hormone (GH), as well as a mediator of GH-independent anabolic responses in many cells and tissues. Low levels of IGF-1 in pre-transplant period, seems to be associated with a lower risk of acute GVHD: a low mitogen stimuli on healthy tissues, mediated by low IGF-1 levels, could reduce damages and tissues inflammation mediated to chemotherapy, but this hypothesis should be confirmed by larger studies.
See this image and copyright information in PMC

References

    1. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN Expert Group Recommendations for Action against Cancer-Related Malnutrition. Clin Nutr (2017) 36:1187–96. 10.1016/j.clnu.2017.06.017 - DOI - PubMed
    1. Brotelle T, Lemal R, Cabrespine A, Combal C, Hermet E, Ravinet A, et al. Prevalence of Malnutrition in Adult Patients Previously Treated with Allogeneic Hematopoietic Stem-Cell Transplantation. Clin Nutr (Edinburgh Scotland) (2018) 37(2):739–45. 10.1016/j.clnu.2017.03.016 - DOI - PubMed
    1. Fuji S, Einsele H, Savani BN, Kapp M. Systematic Nutritional Support in Allogeneic Hematopoietic Stem Cell Transplant Recipients. Biol Blood Marrow Transplant (2015) 21(10):1707–13. 10.1016/j.bbmt.2015.07.003 - DOI - PubMed
    1. Urbain P, Birlinger J, Ihorst G, Biesalski HK, Finke J, Bertz H. Body mass index and bioelectrical impedance phase angle as potentially modifiable nutritional markers are independent risk factors for outcome in allogeneic hematopoietic cell transplantation. Ann Hematol (2013) 92:111–9. 10.1038/bmt.2012.158 - DOI - PubMed
    1. Barritta de Defranchi RL, Bordalejo A, Cañueto I, Villar A, Navarro E. Evolution of Nutritional Status in Patients with Autologous and Allogeneic Hematopoietic Stem Cell Transplant. Supportive Care Cancer (2015) 23(5):1341–47. 10.1007/s00520-014-2473-z - DOI - PubMed