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Graft-versus-host Disease

Malnutrition in patients with chronic GVHD

Bone Marrow Transplantation volume 49, pages 1300–1306 (2014)Cite this article

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Abstract

Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had long-standing, moderate or severe cGVHD and had failed many lines of therapy. Twenty-nine percent (60/210) of subjects were malnourished, using the subjective Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and evaluation. No demographic or transplant characteristics were associated with malnutrition; cGVHD of the lungs, gastrointestinal (GI) tract and mouth, NIH global score, cGVHD symptoms, worse functioning, low albumin, poorer survival and low BMI were associated with malnutrition. A predictive model was developed from all variables of significance: cGVHD of the lungs, GI tract, mouth and BMI accurately predicted 84.2% of malnourished patients as well as 87.2% of well-nourished patients. The PG-SGA questionnaire may be a useful tool in diagnosing nutritional deficits in cGVHD patients undergoing one-time evaluations. Longitudinal prospective studies should assess the utility of nutritional support interventions in cGVHD.

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Acknowledgements

This study was funded by the intramural programs of the National Cancer Institute, Center for Cancer Research and the National Institute of Dental and Craniofacial Research, as well as by the other intramural programs of the National Institutes of Health.

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Authors and Affiliations

  1. Clinical Research Center, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA

    C W Bassim, D Edwards & J W Mays

  2. Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    H Fassil, K Cole, L Grkovic, D Pulanic, K M Williams, R E Gress & S Z Pavletic

  3. Nutrition Department, National Institutes of Health, Bethesda, MD, USA

    M Dobbin

  4. Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    S M Steinberg

  5. Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    K Baird

  6. Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA

    G Joe & L E Comis

  7. Outcomes Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    S A Mitchell

  8. Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia

    L Grkovic & D Pulanic

  9. Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    E W Cowen

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  1. C W Bassim
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  2. H Fassil
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  4. S M Steinberg
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  6. K Cole
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  7. G Joe
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  8. L E Comis
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  9. S A Mitchell
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  10. L Grkovic
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  11. D Edwards
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  12. J W Mays
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  13. E W Cowen
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  14. D Pulanic
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  15. K M Williams
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  16. R E Gress
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  17. S Z Pavletic
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Correspondence to C W Bassim.

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Bassim, C., Fassil, H., Dobbin, M. et al. Malnutrition in patients with chronic GVHD. Bone Marrow Transplant 49, 1300–1306 (2014). https://doi.org/10.1038/bmt.2014.145

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