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Dynamic change of glycemic status during the early phase after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 50, pages 1473–1475 (2015)Cite this article

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Although overall survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has markedly improved, several post-transplant complications remain significant issues, including infectious disease and GVHD. One promising approach to these complications is nutritional intervention, for instance glucose control. Previous studies showed that post-transplant hyperglycemia was a risk factor for morbidities like infectious diseases and GVHD.1, 2 Our group previously performed a pilot study that assessed the feasibility of intensive glucose control (IGC) after allo-HSCT and compared the results with patients in a matched control group.3 We found that supraphysiological doses of insulin (median dose, 50 IU/day) were required to maintain blood glucose (BG) levels within the target range (80–110 mg/dL).3 In addition, even though the mean BG level in the IGC group was significantly lower than that in the control group, the proportion of BG values within the normal range was still unsatisfactory in the IGC group.3

It is difficult to achieve IGC, as shown by the failure in an intensive care unit setting.4 As such, clarification of the mechanisms underlying post-HSCT hyperglycemia is critical. Hyperglycemia may be caused by decreased insulin secretion or by elevated insulin resistance (IR). After allo-HSCT, calcineurin inhibitors reduce the secretion of insulin, and corticosteroids and inflammatory cytokines elevate IR.5 In this study, we sought to clarify the main cause of hyperglycemia during the early phase after HSCT by prospectively monitoring patients’ post-HSCT glycemic status, including BG levels, C-peptide levels and immunoreactive insulin levels.

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Acknowledgements

We thank the medical, nursing, data processing, laboratory and clinical staff at the National Cancer Center Hospital for their important contributions to this study and their dedicated care of the patients. This study was supported in part by grants from the Ministry of Health, Labour and Welfare of Japan. SF designed the research study, performed the research, analyzed the data and wrote the paper. KY, S-WK, KS and TF designed the research study, and performed the research. KY analyzed the data. All authors approved the final version of the manuscript.

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  1. S Fuji and K Yakushijin: These authors contributed equally to this work.

Authors and Affiliations

  1. Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan

    S Fuji, K Yakushijin, S-W Kim, S Kurosawa & T Fukuda

  2. Center for Clinical Research, Kobe University Hospital, Kobe, Japan

    K Yoshimura

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  1. S Fuji
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Correspondence to S Fuji.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Fuji, S., Yakushijin, K., Kim, SW. et al. Dynamic change of glycemic status during the early phase after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 50, 1473–1475 (2015). https://doi.org/10.1038/bmt.2015.163

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