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Pediatric Transplants

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Bone Marrow Transplantation volume 47, pages 1191–1195 (2012)Cite this article

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Abstract

Parenteral nutrition (PN) is the treatment of choice for nutritional support of patients undergoing allo-SCT following myeloablative conditioning (MAC). Here we prospectively assessed the outcomes of early enteral nutrition (EN) in a paediatric cohort. From 2003 to 2010, all 65 consecutive children undergoing MAC allo-SCT at our referral centre began EN the day after transplantation. Post-transplant and nutritional outcomes of patients receiving only EN (EN group, n=50) were compared with those of patients requiring additional PN (EN-PN group, n=15). In the EN group time to platelet recovery (P=0.01) and length of hospitalisation (P<0.001) were shorter, while in the EN-PN group the proportion of unrelated donors (P=0.02) and the frequency of severe acute GVHD (aGVHD; P=0.004) were higher. All patients were alive at day 100. PN was started 14 days after transplant because of poor digestive tolerance to EN or severe gut aGVHD. The body mass index Z-score in the EN-PN group decreased from transplant to discharge (P=0.02). In only 23% of cases was PN required for severely ill patients. Our results suggest that EN might be considered to be an option for nutritional support in children undergoing MAC allo-SCT, while PN should be used only as a rescue option, possibly in combination with EN.

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References

  1. Lipkin AC, Lenssen P, Dickson BJ . Nutrition issues in hematopoietic stem cell transplantation: state of the art. Nutr Clin Pract 2005; 20: 423–439.

    Article  Google Scholar 

  2. Lenssen P, Bruemmer B, Aker SN, McDonald GB . Nutrient support in hematopoietic cell transplantation. J Parenter Enteral Nutr 2001; 25: 219–228.

    Article  CAS  Google Scholar 

  3. Horsley P, Bauer J, Gallagher B . Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay. Bone Marrow Transplant 2005; 35: 1113–1116.

    Article  CAS  Google Scholar 

  4. Taj MM, Pearson AD, Mumford DB, Price L . Effect of nutritional status on the incidence of infection in childhood cancer. Pediatr Hematol Oncol 1993; 10: 283–287.

    Article  CAS  Google Scholar 

  5. Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M . ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clin Nutr 2009; 28: 445–454.

    Article  CAS  Google Scholar 

  6. Weisdorf SA, Lysne J, Wind D, Haake RJ, Sharp HL, Goldman A et al. Positive effect of prophylactic total parenteral nutrition on long-term outcome of bone marrow transplantation. Transplantation 1987; 43: 833–838.

    Article  CAS  Google Scholar 

  7. Day DL, Carpenter BL . Abdominal complications in pediatric bone marrow transplant recipients. Radiographics 1993; 13: 1101–1112.

    Article  CAS  Google Scholar 

  8. Iestra JA, Fibbe WE, Zwinderman AH, Romijn JA, Kromhout D . Parenteral nutrition following intensive cytotoxic therapy: an exploratory study on the need for parenteral nutrition after various treatment approaches for haematological malignancies. Bone Marrow Transplant 1999; 23: 933–939.

    Article  CAS  Google Scholar 

  9. Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G et al. ESPEN guidelines on enteral nutrition: non-surgical oncology. Clin Nutr 2006; 25: 245–259.

    Article  CAS  Google Scholar 

  10. Langdana A, Tully N, Molloy E, Bourke B, O’Meara A . Intensive enteral nutrition support in paediatric bone marrow transplantation. Bone Marrow Transplant 2001; 27: 741–746.

    Article  CAS  Google Scholar 

  11. Sefcick A, Anderton D, Byrne JL, Teahon K, Russell NH . Naso-jejunal feeding in allogeneic bone marrow transplant recipients: results of a pilot study. Bone Marrow Transplant 2001; 28: 1135–1139.

    Article  CAS  Google Scholar 

  12. Papadopoulou A, MacDonald A, Williams MD, Darbyshire PJ, Booth IW . Enteral nutrition after bone marrow transplantation. Arch Dis Child 1997; 77: 131–136.

    Article  CAS  Google Scholar 

  13. Hopman GD, Peña EG, Le Cessie S, Van Weel MH, Vossen JMJJ, Mearin ML . Tube feeding and bone marrow transplantation. Med Pediatr Oncol 2003; 40: 375–379.

    Article  CAS  Google Scholar 

  14. Seguy D, Berthon C, Micol J-B, Darré S, Dalle J-H, Neuville S et al. Enteral feeding and early outcomes of patients undergoing allogeneic stem cell transplantation following myeloablative conditioning. Transplantation 2006; 82: 835–839.

    Article  Google Scholar 

  15. Szeluga DJ, Stuart RK, Brookmeyer R, Utermohlen V, Santos GW . Nutritional support of bone marrow transplant recipients: a prospective, randomized clinical trial comparing total parenteral nutrition to an enteral feeding program. Cancer Res 1987; 47: 3309–3316.

    CAS  Google Scholar 

  16. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  Google Scholar 

  17. Thomas ED, Storb R, Clift RA, Fefer A, Johnson L, Neiman PE et al. Bone marrow transplantation. N Engl J Med 1975; 292: 895–902.

    Article  CAS  Google Scholar 

  18. Sempé M, Pédron G, Roy-Pernot M . Auxologie, Méthode et Séquences. Théraplix: Paris, 1979.

    Google Scholar 

  19. Murray SM, Pindoria S . Nutrition support for bone marrow transplant patients. Cochrane Database Syst Rev 2009: (2): CD002920.

  20. Arfons LM, Lazarus HM . Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo? Bone Marrow Transplant 2005; 36: 281–288.

    Article  CAS  Google Scholar 

  21. Watanabe N, Matsumoto K, Yoshimi A, Horibe K, Matsuyama T, Kojima S et al. Outcome of bone marrow transplantation from HLA-identical sibling donor in children with hematological malignancies using methotrexate alone as prophylaxis for graft-versus-host disease. Int J Hematol 2008; 88: 575–582.

    Article  Google Scholar 

  22. Kennedy-Nasser AA, Bollard CM, Myers GD, Leung KS, Gottschalk S, Zhang Y et al. Comparable outcome of alternative donor and matched sibling donor hematopoietic stem cell transplant for children with acute lymphoblastic leukemia in first or second remission using alemtuzumab in a myeloablative conditioning regimen. Biol Blood Marrow Transplant 2008; 14: 1245–1252.

    Article  CAS  Google Scholar 

  23. Smith AR, Majhail NS, MacMillan ML, DeFor TE, Jodele S, Lehmann LE et al. Hematopoietic cell transplantation comorbidity index predicts transplantation outcomes in pediatric patients. Blood 2011; 117: 2728–2734.

    Article  CAS  Google Scholar 

  24. Shaw PJ, Kan F, Woo Ahn K, Spellman SR, Aljurf M, Ayas M et al. Outcomes of pediatric bone marrow transplantation for leukemia and myelodysplasia using matched sibling, mismatched related, or matched unrelated donors. Blood 2010; 116: 4007–4015.

    Article  CAS  Google Scholar 

  25. Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992; 216: 172–183.

    Article  CAS  Google Scholar 

  26. Iiboshi Y, Nezu R, Kennedy M, Fujii M, Wasa M, Fukuzawa M et al. Total parenteral nutrition decreases luminal mucous gel and increases permeability of small intestine. J Parenter Enteral Nutr 1994; 18: 346–350.

    Article  CAS  Google Scholar 

  27. Ohta K, Omura K, Hirano K, Kanehira E, Ishikawa N, Kato Y et al. The effects of an additive small amount of a low residual diet against total parenteral nutrition-induced gut mucosal barrier. Am J Surg 2003; 185: 79–85.

    Article  Google Scholar 

  28. Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992; 215: 503–511.

    Article  CAS  Google Scholar 

  29. MacFie J, Reddy BS, Gatt M, Jain PK, Sowdi R, Mitchell CJ . Bacterial translocation studied in 927 patients over 13 years. Br J Surg 2006; 93: 87–93.

    Article  CAS  Google Scholar 

  30. Mulder PO, Bouman JG, Gietema JA, Van Rijsbergen H, Mulder NH, Van der Geest S et al. Hyperalimentation in autologous bone marrow transplantation for solid tumors. Comparison of total parenteral versus partial parenteral plus enteral nutrition. Cancer 1989; 64: 2045–2052.

    Article  CAS  Google Scholar 

  31. Heubi JE . Whenever possible, use the gut!. J Pediatr Hematol Oncol 1999; 21: 88–90.

    Article  CAS  Google Scholar 

  32. ASPEN Board of Directors the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients. J Parenter Enteral Nutr 2002; 26 (Suppl 1): 1SA–138SA.

    Google Scholar 

  33. Strasser SI, Shulman HM, McDonald GB . Cholestasis after hematopoietic cell transplantation. Clin Liver Dis 1999; 3: 651–668.

    Article  CAS  Google Scholar 

  34. Mattsson J, Westin S, Edlund S, Remberger M . Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease. Bone Marrow Transplant 2006; 38: 629–633.

    Article  CAS  Google Scholar 

  35. Cetin T, Arpaci F, Dere Y, Turan M, Oztürk B, Kömürcü S et al. Total parenteral nutrition delays platelet engraftment in patients who undergo autologous hematopoietic stem cell transplantation. Nutrition 2002; 18: 599–603.

    Article  CAS  Google Scholar 

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Acknowledgements

We are grateful to C Dendoncker and N Ouk, dieticians from the nutritional support team, the staff of the SCT Unit, the haematology fellows and other senior physicians who participated in this study.

Author contributions: Saba Azarnoush, MD: pediatric trainee, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical review of the manuscript for important intellectual content. Bénédicte Bruno, MD: study concept and design, analysis and interpretation of data, and critical review of the manuscript for important intellectual content. Laurent Beghin: statistical analysis and critical review of the manuscript for important intellectual content. Dominique Guimber, MD: critical review of the manuscript for important intellectual content. Brigitte Nelken, MD: critical review of the manuscript for important intellectual content. Ibrahim Yakoub-Agha, MD, PhD: study concept and design and critical review of the manuscript for important intellectual content. David Seguy, MD, PhD: study concept and design, analysis and interpretation of data, critical review of the manuscript for important intellectual content, and study supervision.

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Authors and Affiliations

  1. Hématologie pédiatrique, Hôpital Jeanne de Flandre, Univ Lille Nord de France, Lille, France

    S Azarnoush, B Bruno & B Nelken

  2. Unité INSERM U995, Institut de Médecine thérapeutique et préventive, Lille, France

    L Beghin

  3. Centre d’Investigation Clinique, Antenne pédiatrique Jeanne de Flandre CIC-9301, Univ Lille Nord de France, Lille, France

    L Beghin

  4. Gastroentérologie pédiatrique, Hôpital Jeanne de Flandre, Univ Lille Nord de France, Lille, France

    D Guimber

  5. Service des Maladies du sang, Hématologie, Hôpital Claude Huriez, Univ Lille Nord de France, Lille, France

    I Yakoub-Agha

  6. Service de Nutrition, Hôpital Claude Huriez, Lille, France

    D Seguy

  7. EA2694, CHRU, Univ Lille Nord de France, Lille, France

    D Seguy

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  1. S Azarnoush
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Correspondence to D Seguy.

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Azarnoush, S., Bruno, B., Beghin, L. et al. Enteral nutrition: a first option for nutritional support of children following allo-SCT?. Bone Marrow Transplant 47, 1191–1195 (2012). https://doi.org/10.1038/bmt.2011.248

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  • DOI: https://doi.org/10.1038/bmt.2011.248

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