Micronutrient requirements for stem cell transplantation patients > 100 days after transplant and during graft versus host disease: a systematic review

Abstract

Purpose: There are no clinical guidelines for micronutrient supplementation and monitoring during the post-acute phase of Stem cell transplantation (SCT) and during graft versus host disease (GVHD). Hence this comprehensive systematic review aimed to evaluate the evidence for vitamin and mineral supplementation and monitoring to inform clinical practice. Methods: Eligible studies included adults who had undergone SCT more than 100 days ago or were experiencing GVHD and were prescribed a micronutrient supplement and/or had micronutrient levels monitored. Human studies published in English were retrieved from five databases (Embase, Medline, Scopus, Web of Science, and CINAHL) on the 24th of May 2024. The risk of bias and certainty of evidence were assessed through the Academy of Nutrition and Dietetics Quality Criteria Checklist and The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. No meta-analysis was completed as part of this systematic review. Results: Sixteen studies (n = 1573) met eligibility criteria for inclusion. Micronutrients examined by these studies were vitamin D, calcium, and vitamin A. All studies had a neutral risk of bias. Studies reported variable prevalence of vitamin D deficiency, with mixed results regarding the association between vitamin D or calcium and the outcomes of reduced bone mineral density (BMD), chronic GVHD, mortality, sarcopenia, or fractures. The GRADE certainty of evidence for vitamin D or calcium and BMD was very low. Conclusion: The impact of micronutrient supplementation on clinical outcomes is unclear, however, monitoring vitamin D levels and calcium intake after SCT should be considered to detect deficiency or inadequate intake.