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The European Society for Blood and Marrow Transplantation (EBMT) roadmap and perspectives to improve nutritional care in patients undergoing hematopoietic stem cell transplantation on behalf of the Cellular Therapy and Immunobiology Working Party (CTIWP) and the Nurses Group (NG) of the EBMT

Bone Marrow Transplantation volume 58, pages 965–972 (2023)Cite this article

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Abstract

Malnutrition is the most common comorbidity during the continuum of hematopoietic stem cell transplant (HSCT) and negatively impacts clinical outcomes, response to therapy, quality of life, and costs. The intensive conditioning regimen administered before transplant causes inflammatory damages to the gastrointestinal system, which themselves contribute to trigger graft versus host disease (GvHD) in the allogeneic setting. GvHD and other post-transplant complications such as infections adversely affect food intake and gut absorption of nutrients. Consequently, patients exhibit signs of malnutrition such as weight loss and muscle wasting, thus triggering a “vicious circle” that favours additional complications. Among HSCT centres, there is marked variability in nutritional care, from screening for malnutrition to nutritional intervention. The present paper, elaborated by the Cellular Therapy and Immunobiology Working Party and the Nurses Group of the European Society for Blood and Marrow Transplantation, aims at defining a roadmap that identifies the main nutritional critical issues in the field of HSCT. This document will be propaedeutic to the development of clinical algorithms to counteract risk factors of malnutrition, based on scientific evidence and shared among HSCT centres, and thus maximize transplant outcomes.

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Fig. 1: Risk factors of malnutrition during all the continuum of HSCT.
Fig. 2: Flow-chart for the ideal timing of different interventions.

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Acknowledgements

This work was partially supported by Ricerca Corrente, grant number 08067615, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

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Author notes

  1. These authors contributed equally: Amanda Casirati, Riccardo Caccialanza.

Authors and Affiliations

  1. Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Amanda Casirati, Emanuele Cereda & Riccardo Caccialanza

  2. Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain

    Isabel Salcedo

  3. Centre de Thérapie Cellulaire & Centre d’Investigations Cliniques en Biothérapies Inserm CBT-1409, Institut Paoli-Calmettes, Marseille, France

    Christian Chabannon

  4. Hematology and BMT Unit, San Raffaele Scientific Institute, Milan, Italy

    Annalisa Ruggeri

  5. Department of Hematology and Center for Translational Immunology, UMC Utrecht, Utrecht, The Netherlands

    Jurgen Kuball

  6. Department of Haematology and Transplant Unit, The Christie Hospital, Manchester, United Kingdom

    Ruth Clout

  7. EBMT Statistical Unit, Leiden, The Netherlands

    Jarl E. Mooyaart

  8. Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom

    Michelle Kenyon

  9. Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy

    Paolo Pedrazzoli

  10. Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Paolo Pedrazzoli

  11. Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden and Institute of Health Sciences, Lund University, Lund, Sweden

    Annika M. Kisch

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  10. Riccardo Caccialanza
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  11. Paolo Pedrazzoli
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  12. Annika M. Kisch
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Consortia

Cellular Therapy and Immunobiology Working Party

  • Emanuele Cereda
  • , Christian Chabannon
  • , Annalisa Ruggeri
  • , Jurgen Kuball
  • , Jarl E. Mooyaart
  • , Riccardo Caccialanza
  •  & Paolo Pedrazzoli

the Nurses Group of the EBMT

  • Amanda Casirati
  • , Isabel Salcedo
  • , Ruth Clout
  • , Michelle Kenyon
  •  & Annika M. Kisch

Contributions

Conceptualization: PP, RC, AK. Methodology: EC, AC, AK, RC, PP, IS. Data Curation: AC, AR, RuC, JM. Writing—Original Draft: AC, RC, PP, IS, AK, CC. Writing—Review & Editing: All authors. Supervision: EC, JK, MK, RC, PP, AK. Project administration: PP, AK.

Corresponding author

Correspondence to Paolo Pedrazzoli.

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The authors declare no competing interests.

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Casirati, A., Salcedo, I., Cereda, E. et al. The European Society for Blood and Marrow Transplantation (EBMT) roadmap and perspectives to improve nutritional care in patients undergoing hematopoietic stem cell transplantation on behalf of the Cellular Therapy and Immunobiology Working Party (CTIWP) and the Nurses Group (NG) of the EBMT. Bone Marrow Transplant 58, 965–972 (2023). https://doi.org/10.1038/s41409-023-02018-z

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  • DOI: https://doi.org/10.1038/s41409-023-02018-z

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