Graft-vs-host disease (GVHD) is a major complication after
allogeneic hematopoietic stem cell transplantation. Both acute and chronic
forms of GVHD are challenging to manage medically and nutritionally. Patients
with advanced GVHD commonly become depleted nutritionally, with loss of lean
body mass (LBM) and functional status. We present 2 case reports of patients
who developed GVHD and subsequent nutrition decline. Although both patients
were candidates for specialized nutrition support (SNS), only 1 was able to
receive enteral and parenteral nutrition due to GVHD complications preventing
access for provision of SNS. Fortunately, the patients have remained in
remission from their hematologic malignancy, but they continue to cope with
chronic GVHD and its consequences. These cases exhibit the complexity of
managing a patient with extensive GVHD and nutrition interventions for
clinicians to consider to optimize outcomes.
Get full access to this article
View all access options for this article.
References
1.
Baron F, Storb R, Little M. Hematopoietic cell transplantation:
five decades of progress. Arch Med Res.2003
;34:528–
544.
2.
Tabbara IA, Zimmerman K, Morgan C, Nahleh Z. Allogeneic
hematopoietic stem cell transplantation. Arch Intern
Med.2002; 162:1558–
1566.
3.
International Bone Marrow Transplant Registry. International bone
marrow transplant registry. Available at:
http://www.ibmtr.org.
Accessed January 10, 2005.
4.
Roberts S, Vanzee J. Nonmyeloablative stem cell transplantation and
its nutritional consequences. Support Line.2003
;25:3–
9.
5.
Ratanatharathorn V, Ayash L, Lazarus HM, Fu J, Uberti JP. Chronic
graft-versus-host disease: clinical manifestation and therapy. Bone
Marrow Transplant.2001;28:121–
129.
6.
Klingebiel T, Schlegel PG. GVHD: overview on pathophysiology,
incidence, clinical, and biological features. Bone Marrow
Transplant.1998;21(suppl):S45–
S49.
Vogelsang GB, Lee L, Bensen-Kennedy DM. Pathogenesis and treatment
of graft-versus-host disease after bone marrow transplant. Annu Rev
Med.2003;54:29–
52.
9.
Shulman HM, Sullivan KM, Weiden PI, et al. Chronic
graft-versus-host syndrome in man: a long-term clinicopathologic study of 20
Seattle patients. Am J Med.1980
;69:204–
217.
Bacigalupo A, Palandri R. Management of acute graft versus host
disease. Hematol J.2004
;5:189–
196.
15.
Nordlander A, Mattsson J, Ringden O, et al. Graft-versus-host
disease is associated with a lower relapse incidence after hematopoietic stem
cell transplantation in patients with acute lymphoblastic leukemia.
Biol Blood Marrow Transplant.2004
;10:195–
203.
16.
Muscaritoli M, Grieco G, Capria S, Iori AP, Rossi FF. Nutritional
and metabolic support in patients undergoing bone marrow transplantation.
Am J Clin Nutr.2002
;75:183–
190.
17.
Lenssen P, Bruemmer B, Aker SN, McDonald GB. Nutrient support in
hematopoietic cell transplantation. JPEN J Parenter Enteral
Nutr.2001;25:219–
228.
18.
Ross V. Micronutrient recommendations for wound healing.
Support Line.2002
;24:3–
9.
19.
Scholl D, Langkamp-Henken B. Nutrient recommendations for wound
healing. J IV Nurs.2001
;24:124–
132.
20.
Takatsuka H, Takemoto Y, Iwata N, et al. Oral eicosapentaenoic acid
for complications of bone marrow transplantation. Bone Marrow
Transplant.2001;28:769–
774.
21.
Lenssen P. Hematopoietic cell transplantation. In: Matarese LE,
Gottschlich MM, eds. Contemporary Nutrition Support
Practice. St. Louis, MO: W.B. Saunders Co: 2003:574–
594.
22.
Lenssen P, Aker SN. Adult hematopoietic stem cell transplantation.
In: Hasse JM, Blue LS, eds. Comprehensive Guide to Transplant
Nutrition. Chicago, IL: American Dietetic Association;2002
: 123–152.
23.
Lenssen P, Sherry ME, Cheney CL, et al. Prevalence of
nutrition-related problems among long-term survivors of allogeneic marrow
transplantation. J Am Diet Assoc.1990
;90:835–
842.
24.
Jacobsohn DA, Margolis J, Doherty J, Anders V, Vogelsang GB. Weight
loss and malnutrition in patients with chronic graft-versus-host disease.
Bone Marrow Transplant.2002
;29:231–
236.
