Nutrition Support Practices of Hematopoietic Stem Cell Transplantation Centers in Mainland China
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40(4):691-698,2020
691
Nutrition Support Practices of Hematopoietic Stem Cell Transplantation Centers in Mainland China Yun FANG1, Min-jie LIU1#, Wei-wei ZHANG1, Chen XIE1, Zhun-zhun LIU2 1 Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China 2 Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany Huazhong University of Science and Technology 2020
Summary: It has been identified that malnutrition can influence the immune system and time of engraftment, and it’s also associated with increased incidence of complications, prolonged length of hospital stays, and transplant mortality and morbidity in patients undergoing hematopoietic stem cell transplantation (HSCT), so dynamic nutrition care is highly important. The aim of this study was to better understand the differences between clinical nutrition practices and international recommendations as well as possible barriers to the use of nutrition support in HSCT patients. An evidence-based nutrition support pathway was constructed through a systematic literature review to identify evidence and recommendations relating to the relevant issues. Then, a questionnaire consisting of 28 questions that focused on the 4 topics, namely, assessment and screening for malnutrition, nutrition support interventions, nutrition support in gastrointestinal graft-versushost disease (GVHD) and neutropenic diet was developed by the study authors and used for data collection. Responses of 18 HSCT centers from 17 provinces were received. General assessment for malnutrition was performed at 72% (13/18) centers. Parenteral nutrition (PN) was given as the first option to HSCT patients in the majority of centers, despite the fact that current guidelines recommend enteral nutrition (EN) over PN. As many as 72% (13/18) of the centers considered a neutropenic diet in the management of HSCT patients, but only one center had a formal neutropenic diet protocol in place for transplant recipients. Criteria for initiating nutrition support in patients with gastrointestinal GVHD were heterogeneous among the centers, and PN was the most widely used technique. The survey results revealed significant heterogeneity with regard to nutrition support practices among the centers, as well as between the practices and the guidelines. Standard nutrition support guidelines or protocols for nutrition support practices were absent in most of the centers. Key words: hematopoietic stem cell transplant; malnutrition; nutrition support practice
Hematopoietic stem cell transplantation (HSCT) has become a standard treatment option for hematological diseases and malignancies. However, conditioning regimens before HSCT, including conditioning with myeloablative chemotherapy and total body irradiation-based myeloablative regimens, may cause severe side effects, such as mouth dryness, changes in taste, loss of appetite, nausea, vomiting, and diarrhea. Complications after HSCT such as mucositis, graft-versus-host disease (GVH
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