Nutritional support in adult patients undergoing allogeneic stem cell transplantation following myeloablative conditioning

Abstract

Allogeneic stem cell transplantation (allo- SCT) and its consequences are a perfect illustration of the different pathophysiological pathways leading to protein–energy malnutrition, which is characterized by a decrease in oral intake, an increase in metabolic needs, and the appearance of digestive losses. Malnutrition is a crucial target because of its consequences for morbidity and mortality in recipients. Thus, nutritional assessment, counseling, and intervention should be incorporated systematically into the care of each patient. Posttransplantation support includes monitoring of nutritional status and metabolic disorders, prevention of micronutrient deficiencies, promotion of low-microbial oral feeding, and rational use of both enteral nutrition (EN) and parenteral nutrition (PN). Rather than being opposing strategies, EN and PN are complementary in the care of disease–related malnutrition. EN appears useful for limiting gut atrophy and bacterial translocation, which promote sepsis and acute graft–versus–host disease, whereas PN becomes a rescue option when oral or enteral intake is insufficient or impossible. However, PN cannot substitute for the effect of EN on gut trophicity. Future research on nutritional support for allo–SCT patients should focus on this complementarity and should define more precisely the place of immunonutrients, such as glutamine, according to the type of transplant.