PB2269 PARENTERAL NUTRITION AND ACUTE GVHD IN HEMATOPOIETIC STEM CELLS TRANSPLANTATION: A PROSPECTIVE OBSERVATIONAL COHORT STUDY
Authors: Arena F. , Morello E. , Bertocchi G. , Malagola M. , Samarani E. , Bertulli A. , Farina M. , Gandolfi L. , Polverelli N. , Turra A. , Cattina F. , Andreoli M. , Russo D. 
Published: June 2019

Background:

Allogenic stem cells transplantation (Allo‐SCT) is associated with oral mucositis, dysgeusia, nausea, vomiting, diarrhea and abdominal pain that can affect food intake and nutritional status. Parenteral nutrition (PN) can be adopted to contrast these side effects, but no clear data are available concerning the impact of this approach on transplant outcome.

Aims:

The primary aim of this prospective observational study was to evaluate if the use of total parenteral nutrition (TPN), administered following clinical practice, was associated to transplant‐related complications.

Methods:

Between August 2017 and August 2018, we performed an observational prospective study on 30 adult patients consecutively submitted to allo‐SCT for hematological malignancies in our Center. The nutritional status was weekly assessed by a dietitian from the day of admission to day +30, and it was classified according to PG‐SGA score. The higher the score, the worse is the nutritional status. In our cohort, total parenteral nutrition (TPN) was administered in case of oral mucositis grade 3‐4, intractable diarrhea and/or vomiting, and if patients were unable to ingest adequate nutrients for at least three days. The cohort who received TPN was compared with the group who used partial parenteral nutrition or ate naturally (No TPN).

Results:

Mean patient age was 50.7 ± 20.7 years and 14/30 (47%) patients were male. Medium duration of hospitalization was 39.3 ± 13.4 days. Acute myeloid leukemia was the most frequent diagnosis (47%). The donor was a matched unrelated, a HLA sibling and a haploidentical one in 17/30 (57%), 8/30 (27%) and 5/30 (16%) cases, respectively. Non‐myeloablative conditioning was administered in 19/30 (63%) and myeloablative in 11/30 (37%). TBI was part of the conditioning in 8/30 cases (27%). Most of the patients (74%) were well nourished at admission. However, from day +21, all the patients were malnourished. TPN was administered in 19/30 (63%) patients, while 11/30 (37%) ate naturally or received partial parenteral nutrition (No TPN). At admission, no statistically significant differences were found between TPN group and No TPN group in nutritional status (PG‐SGA score: 6.7 ± 4.2 vs 5.0 ± 1.1 and BMI: 23.4 ± 4.7 vs 24.9 ± 1.9 Kg/sqm). From the day of transplantation to day +28, the TPN group was more malnourished than No TPN group (P<0.05). During hospitalization, patients in the No TPN group showed a lower weight loss (5.9% vs 7.4%; p = 0.198) and a lower mid‐arm circumference loss (6.7% vs 9.1%; p = 0.154). The TPN group had higher length of hospitalization compared to the No TPN group (42.3 ± 15.3 VS 34.1 ± 7.5 days) (P = 0.106). Between TPN group and No TPN group no statistically significant difference was found in mortality at +30 (5.3% vs 0%; p = 0.265) and at +100 (15.7% vs 18.2%; p = 0.427). Acute GVHD was observed in 10/19 (53%) patients in the TPN group versus 1/11 (9%) patients in the No TPN group (P = 0.016) (Figure 1).

Summary/Conclusion:

The incidence of aGVHD was higher in patients who received TPN (53% vs 9%; p = 0.016). In addition, TPN group had no benefits in terms of nutritional status, weight loss, mid‐arm circumference loss and length of hospitalization. Larger controlled studies are required to confirm this data and to better elucidate the role of gut rest in the development of an inflammatory response.

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