An Observational Study on the Variability of Nutritional Status and Its Impact on Transplant Outcomes in Patients Undergoing Hematopoietic Stem Cell Transplant
Authors: Gupta Manasi , Chaudhary Vijay , DS Pavitra , Joyal Wesley , Vats Kashika , Aggarwal Himanshu , Trivedi Chirag , John M. Joseph 
Published: December 2024

Aims

Malnutrition in recipients of hematopoietic stem cell transplant can lead to increased risk of transplant related complications, prolonged hospitalization and higher incidence of morbidity and mortality. The present study aims to study the variability of nutritional status during the pre- and post-transplant period, factors influencing the same and the impact of malnutrition on transplant outcomes.

Methods

This is an ambispective observational study which was carried out in the department of Clinical Haematology at Christian Medical College and Hospital, Ludhiana. Baseline demographic and transplant details were collected for all the patients. Weight and calorie intake were checked at baseline, day 0, day +7, day +14, day +21, day +30 and day +60 for the prospective group and till day +21 for the retrospective group. Other parameters, including documented infections, incidence of mucositis, occurrence of acute GVHD, length of hospital stay, and non-relapse mortality, were also assessed for their correlation with nutritional status.

Results

A total of 50 subjects (26 prospective and 24 retrospective) were analyzed. The median age for the study subjects was 19.5 years (2-64 years) and majority were males (58%). Most common indication for transplant was thalassemia (40%) followed by multiple myeloma (20%). Seventy two percent of the transplants were allogeneic out of which 75% were matched related donor. Majority (62%) of the study subjects had normal nutritional status at time of transplant, 16% were obese, 14% overweight and 8% were underweight. Three out of the 4 underweight subjects had thalassemia.

Mean percentage weight change showed a declining trend post-transplant with maximum change at Day+30 (-7.65%). Maximum decline in mean calorie intake was seen on Day +7 (-441 Kcal, -29%) following which there was a slow increase in calorie intake. Mean percentage weight change at Day +60 was -7.6%, however mean difference in calorie intake from baseline was only -78.9 Kcal (-2.59%). Repeated measures anova test showed significant change in weight from baseline at Day 0, Day +7, Day +14, Day +21, Day +30 and Day +60 (p&lt;0.001); and calories from baseline at Day 0, Day +7 and Day +14 (p&lt;0.001).

Mucositis was seen in 36% cases, acute GVHD in 52% of the allogeneic transplant recipients and infection requiring antibiotics in 98% cases. Most common infections seen were bacterial (62%) followed by viral (32%) and fungal (30%). Mean length of hospital stay was 36 days. Median duration of follow-up was 1 year. Overall survival (OS) at 1 year was 68% and median OS was not reached.

No statistically significant association was seen between baseline grade of malnutrition and incidence of mucositis, GVHD, infections and mean length of hospital stay. However, over 50% of the underweight, obese and overweight subjects had mucositis as compared to 25.8% with normal nutritional status. Incidence of GVHD was maximum in the underweight group (50%). There was no correlation between OS and grade of malnutrition.

Conclusion

There was a significant decline in weight and calorie intake post-transplant with maximum decrease in calorie intake one-week and maximum loss of weight 1-month post-transplant. Early intervention aimed at better enteral and parenteral nutrition in the peri-transplant transplant period can help in minimizing the weight loss and calorie deficit which can improve the outcomes and quality of life of the transplant recipients.