Examination of a nutritional treatment pathway according to pretreatment health status and stress levels of patients undergoing hematopoietic stem cell transplantation

Abstract

Introduction: This study aimed to validate hematopoietic stem cell transplantation (HSCT) treatment via a tailored nutritional pathway in myeloablative conditioning (MAC), determine its efficacy in terms of remission, and explore associations between clinical outcomes and nutritional indicators.

Methods: We included patients who underwent MAC for HSCT at the Shizuoka Cancer Center Stem Cell Transplantation between 2015 and 2019. We evaluated outcomes from the day before treatment initiation (transplant date: day 0) to day 42.

Results: Among the 40 MAC cases (participant characteristics: 20/40 males, mean age of 52 years, and mean body mass index of 21.9 kg/m2), we found that the percent loss of body weight and loss of skeletal muscle mass were correlated with the basal energy expenditure rate (BEE rate; r = 0.70, p<0.001 and r = 0.49, p<0.01, respectively). Based on the receiver operating characteristics curves, the cutoff value for the BEE rate in terms of weight loss was 1.1. Salivary amylase levels did not significantly change during the treatment course. Continuous variables, including oral caloric intake and performance status, showed statistically significant correlations with nutrition-related adverse events during treatment (r = -0.93, p<0.01 and r = 0.91, p<0.01, respectively). Skeletal muscle mass before treatment initiation was an independent predictive variable for reduced 2-year survival (p = 0.04).

Conclusion: Our results support the validity of a safe nutritional pathway with a BEE rate of 1.1 for HSCT patients pretreated with MAC. Specifically, we found that this pathway could prevent weight loss in response to nutrition-related adverse events. Skeletal muscle mass before treatment was identified as an independent risk factor for reduced 2-year survival.

Fig 1. The nutritional pathway implemented based on nutritional guidance by the Shizuoka Cancer Center blood and hematopoietic cell transplantation team.

Fig 2. Flowchart of the patient selection and enrollment process.

Fig 3. Weight loss rate: %LBW, skeletal muscle loss rate: %LSMM, and basal metabolic calorie sufficiency rate: BEE rate from T1 to T2.

Fig 4. Grip and pinch strength and salivary amylase activity values at T1, on the engraftment date, and at T2.

Lower right photo: Left, grip strength meter; upper right, salivary amylase monitor; lower right, pinch strength meter.

Fig 5. Receiver operating characteristic curve for weight loss and basal energy expenditure sufficiency rate from T1 to T2.

Fig 6. Association between two-year survival, mortality, and clinical indicators.

Fig 7. Nutrition-related adverse events and oral caloric intake from T1 to T2 and standard weight and performance status assessments over time.

Fig 8. Changes in and associations with serum albumin and C-reactive protein values.