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Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review

Bone Marrow Transplantation volume 52, pages 506–513 (2017)Cite this article

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Abstract

In 2009, the American Society of Parenteral and Enteral Nutrition and its European counterpart (Euopean Society for Parenteral and Enteral Nutrition) published guidelines regarding nutritional support of patients with hematologic stem cell transplantation. Our aim was to do an up-to-date literature review regarding benefit of nutritional interventions and treatment recommendations. We searched MEDLINE, EMBASE and Cochrane Library for interventional and observational clinical studies. We extracted data based on a predefined case report form and assessed bias. Out of 459 potential abstracts, 13 studies of mostly moderate quality with a total of 18 167 patients were included. Two very large trials reported negative associations of malnutrition and survival, transplant-related mortality and relapse risk. Some trials found enteral nutrition (EN) to be as effective as parenteral nutrition (PN) with lower complication rates. In addition, EN was associated with better survival, less acute GvHD and faster neutrophil recovery. A neutropenic diet was not superior regarding overall survival, but in contrast resulted in higher infection risk. Current moderate quality studies show negative associations of malnutrition and clinical outcomes, with EN being superior to PN. There was no benefit of neutropenic diets. Large, randomized controlled studies are needed to better understand optimal nutritional support in this patient population.

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Acknowledgements

We thank Heidrun Janka for her excellent support in designing the database search. This study was supported in part by the Swiss National Science Foundation (SNSF Professorship, PP00P3_150531/1) and the Research Council of the Kantonsspital Aarau (1410.000.044).

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Authors and Affiliations

  1. Division of Endocrinology/Metabolism/Clinical Nutrition, Medical University Department, Aarau and Medical Faculty of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland

    A Baumgartner, A Bargetzi, N Zueger, L Bounoure, F Gomes, B Mueller & P Schuetz

  2. Division of Oncology/Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland

    M Bargetzi

  3. Department of Hematology, University Hospital Basel, Basel, Switzerland

    M Medinger

  4. Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, University of Bern, Switzerland

    Z Stanga

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  1. A Baumgartner
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PS and ZS have received research grants from Nestle and Abbott. All other authors declare no conflict of interests.

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Baumgartner, A., Bargetzi, A., Zueger, N. et al. Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review. Bone Marrow Transplant 52, 506–513 (2017). https://doi.org/10.1038/bmt.2016.310

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