The use of hematopoietic stem cell transplantation (HSCT) continues to increase as a treatment for a variety of malignant and nonmalignant disorders. Metabolic and nutrition management of HSCT patients is dependent on the underlying disease, the conditioning regimen, and other transplant-related complications. Supportive care for HSCT patients may include specialized nutrition support. Altered metabolism associated with the conditioning regimen and other transplant-related complications will dictate the route of nutrition intervention and changes in macronutrient and micronutrient requirements. Although many patients are poor candidates for nasoenteric feeding early after HSCT, the best candidate for parenteral nutrition has not been defined. This article reviews the role of specialized nutrition support in adults receiving HSCT, with a focus on clinical application.
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References
1.
1. To LB, Haylock DN, Simmons PJ, et al. The biology and clinical uses of blood stem cells. Blood1997;89:2233–58.
2.
2. Goldman JM, Schmitz N, Niethammer D, et al. Allogeneic and autologous transplantation for haematological diseases, solid tumors and immune disorders: current practice in Europe in 1998. Bone Marrow Transplant1998;12:1–7.
3.
3. Armitage JO.Bone marrow transplantation. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine, 14th ed, New York: McGraw-Hill, 1998;724–30.
4.
4. Cagnoni PJ, Shpall EJ.High-dose chemotherapy for the treatment of breast and ovarian cancer. Curr Opinion Oncol1997;9:122–5.
5.
5. Fields KK, Elfenbein GJ, Perkins JB, et al. Defining the role of novel high-dose chemotherapy regimens for the treatment of high-risk breast cancer. Semin Oncol1998;25 (Suppl):1–2.
6.
6. Weisdorf SA, Lysne J, Wind D, et al. Positive effect of prophylactic TPN on long-term outcome of bone marrow transplantation. Transplantation1987;43:833–8.
7.
7. Ziegler TR, Young LS, Benfell K, et al. Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind study. Ann Intern Med1992;116:821–8.
8.
8. Schloerb PR, Amare M.TPN with glutamine in bone marrow transplantation and other clinical applications (a randomized, double-blind study). JPEN1993;17:407–13.
9.
9. Jebb SA, Marcus R, Elia M.A pilot study of oral glutamine supplementation in patients receiving bone marrow transplants. Clin Nutr1995;14:162–5.
10.
10. Lenssen P, Bruemmer BA, Bowden RA, et al. Intravenous lipid dose and incidence of bacteremia and fungemia in patients undergoing bone marrow transplantation. Am J Clin Nutr1998;67:927–33.
11.
11. Zerbe MB, Parkerson SG, Ortlieb ML, et al. Relationship between oral mucositis and treatment variables in bone marrow transplant patients. Cancer Nursing1992;15:196–205.
13. Petersen FB, Bearman SI.Preparative regimens and their toxicity. In: Forman SJ, Blume KG, Thomas ED, eds. Bone Marrow Transplantation. Cambridge, MA: Blackwell Scientific Publications, 1994;79–95.
14.
14. Rubenfeld GD, Crawford SW.Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med1996;125: 625–33.
15.
15. Nevo S, Swan V, Enger C, et al. Acute bleeding after bone marrow transplantation (BMT)—incidence and effect on survival. A quantitative analysis in 1,402 patients. Blood1998;91:1469–77.
16.
16. Merouani A, Shpall EJ, Jones RB, et al. Renal function in high dose chemotherapy and autologous hematopoietic cell support treatment for breast cancer. Kidney Int1996;50:1026–31.
17.
17. Herrmann VM, Petruska PJ.Nutrition support in bone marrow transplant recipients. Nutr Clin Pract1993;8:19–27.
18.
18. Copeland EM III.Intravenous hyperalimentation and cancer. A historical perspective. JPEN1986;10:337–42.
19.
19. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group.Perioperative total parenteral nutrition in surgical patients. N Engl J Med1991;325:525–32.
20.
20. ASPEN Board of Directors.Guidelines for the use of parenteral an enteral nutrition in adult and pediatric pateints. JPEN1993;17:5SA.
21.
21. Deeg HJ, Seidel K, Bruemmer B, et al. Impact of patient weight on non-relapse mortality after marrow transplantation. Bone Marrow Transplant1995;15:461–68.
22.
22. Weidsorf S, Hofland C, Sharp H, et al. TPN in bone marrow transplantation: a clinical evaluation. J Pediatr Gastroenterol Nutr1984;3:95–100.
23.
23. Mick R, Williams SF, Bitran JD.Patients at increased risk for late engraftment after transplantation: a novel method for their identification. Bone Marrow Transplant1990;6:185–91.
24.
24. Klein S, Koretz RL.Nutrition support in patients with cancer: what do the data really show?Nutr Clin Pract1994;9:91–100.
25.
25. McGreer AJ, Detsky AS, O'Rourke K.Parenteral nutrition in patients receiving cancer chemotherapy. Ann Intern Med1989;110:734–36.
26.
26. Szeszycki EE, Griffith DP, Puckett AB, et al. Efficacy of parenteral nutrition in hospitalized bone marrow transplant (BMT) patients: a pilot study (Abstr). JPEN1998;22 (Suppl):S9.
27.
27. Copeland EM III.Historical perspective on nutritional support of cancer patients. CA Cancer J Clin1998;48:67–8.
28.
28. Bergerson SL.Nutritional support in bone marrow transplant recipients. In: Burt RK, Deeg HJ, Lothian ST, et al, eds. On Call in Bone Marrow Transplantation. Austin, TX: RG Landes Company, 1992;343–56.
29.
29. Roberts SR, Miller JE.Success using PEG tubes in marrow transplant recipients. Nutr Clin Pract1998;13:74–8.
30.
30. Charuhas PM, Fosberg KL, Bruemmer B, et al. A double-blind randomized trial comparing outpatient parenteral nutrition with intravenous hydration: effect on resumption of oral intake after marrow transplantation. JPEN1997;21:157–61.
31.
31. Geibig CB, Ponting Owens J, Mirtallo JM, et al. Parenteral nutrition for marrow transplant recipients: evaluation of an increased nitrogen dose. JPEN1991;15:184–8.
32.
32. Lenssen P, Cheney CL, Aker SN, et al. Intravenous branched chain amino acid trial in marrow transplant recipients. JPEN1987;11:112–3.
33.
33. Keller U, Kraenzlin ME, Gratwohl A, et al. Protein metabolism assessed by 1-13C leucine infusions in patients undergoing bone marrow transplantation. JPEN1990;14:480–4.
34.
34. Cheney CL, Abson KG, Aker SN, et al. Body composition changes in marrow transplant recipients receiving TPN. Cancer1987;59:1515–9.
35.
35. Van Zaanen HCT, Van der Lelie H, Timmer JG, et al. Parenteral glutamine dipeptide supplementation does not ameliorate chemotherapy-induced toxicity. Cancer1994;74:2879–84.
37. National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition.Safe practices for parenteral nutrition formulations. JPEN1998;22:49–66.
38.
38. MacBurney M, Young LS, Ziegler TR, et al. A cost-evaluation of glutamine-supplemented parenteral nutrition in adult bone marrow transplant patients. J Am Diet Assoc1994;94:1263–6.
39.
39. Ziegler TR, Benfell K, Smith RJ, et al. Safety and metabolic effects of [L]-glutamine administration in humans. JPEN1990;14 (Suppl):137S–46S.
40.
40. Lenssen P, Spencer GD, McDonald GB.A randomized trial of Freamine vs. Hepatamine vs. placebo in acute hepatic coma. Gastroenterology1987;92:1749.
41.
41. Kaproth PL, Barber JR, Moore R, et al. Parenteral nutrition in a bone marrow transplant patient with hepatic complications. Nutr Clin Pract1990;5:18–22.
42.
42. Bearman SI.The syndrome of hepatic veno-occlusive disease after marrow transplantation. Blood1995;85:3005–20.
43.
43. Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. JPEN1997;21:133–56.
44.
44. Naylor CD, O'Rourke K, Detsky AS, et al. Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy. A meta-analysis. Gastroenterology1989;97:1033–42.
45.
45. Szeluga DJ, Stuart RK, Brookmeyer R, et al. Energy requirements of parenterally fed bone marrow transplant recipients. JPEN1985;9:139–43.
46.
46. Peters E, Beck J, Lemaistre C, et al. Changes in resting energy expenditure (REE) during allogeneic bone marrow transplantation (ABMT). Am J Clin Nutr1990;51:521.
47.
47. Tomalis L, Kennedy MJ, Caballero B.Resting energy expenditure in patients undergoing autologous bone marrow transplant. JPEN1994;18 (Suppl):27S.
48.
48. Cerra FB, Benitez MR, Blackburn GL, et al. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest1997;111:769–78.
49.
49. McMahon MM.What to do about hyperglycemia in hospitalized patients. Nutr Clin Pract1997;12:35–41.
50.
50. Jensen GL, Mascioli EA, Seidner DL, et al. Parenteral infusion of long-and medium-chain triglycerides and reticuloendothelial system function in man. JPEN1990;14:467–71.
51.
51. Waitzberg DL, Bellinati-Pires R, Salgado MM, et al. Effect of TPN with different lipid emulsions on human monocyte and neutrophil functions. Nutrition1997;13:128–32.
52.
52. Gottschlich MM.Selection of optimal lipid sources in enteral and parenteral nutrition. Nutr Clin Pract1992;7:152–65.
53.
53. Clemens MR, Ladner C, Ehninger G, et al. Plasma vitamin E and β-carotene concentrations during radiochemotherapy preceding bone marrow transplantation. Am J Clin Nutr1990;51:216–9.
54.
54. Nattakom TV, Charlton A, Wilmore DW.Use of vitamin E and glutamine in the successful treatment of severe veno-occlusive disease following bone marrow transplantation. Nutr Clin Pract1995;10:16–8.
55.
55. Bleggi-Torres LF,de Medeiros BC, Ogasawara VSA, et al. Iatrogenic Wernicke's encephalopathy in allogeneic bone marrow transplantation: a study of eight cases. Bone Marrow Transplant1997;20:391–5.
56.
56. Elston TN, Dudley JM, Shearer MJ, et al. Vitamin K prophylaxis in high-dose chemotherapy. Lancet1995;345:1245.
57.
57. Antila HM, Salo MS, Kirvela O, et al. Serum trace element concentrations and iron metabolism in allogeneic bone marrow transplant recipients. Ann Med1992;24:55–9.
58.
58. Fredstrom S, Rogosheske J, Gupta P, et al. Extrapyramidal symptoms in a BMT recipient with hyperintense basal ganglia and elevated manganese. Bone Marrow Transplant1995;15:989–92.
59.
59. McEvoy GK, ed.Furosemide. AHFS Drug Information 98. Bethesda, MD: American Society of Hospital Pharmacists, 1998: 2188–92.
60.
60. McEvoy GK, ed.Amphotericin B. AHFS Drug Information 98. Bethesda, MD: American Society of Hospital Pharmacists, 1998; 85–96.
61.
61. Fields KK, Elfenbein GJ, Lazarus HM, et al. Maximum-tolerated doses of ifosfamide, carboplatin, and etoposide given over 6 days followed by autologous stem-cell rescue: toxicity profile. J Clin Oncol1995;13:323–32.
62.
62. McEvoy GK, ed.Cyclosporine. AHFS Drug Information 98.Bethesda, MD: American Society of Hospital Pharmacists, 1998; 3057–68.
63.
63. McEvoy GK, ed. Spironolactone. AHFS Drug Information 98. Bethesda, MD: American Society of Hospital Pharmacists, 1998; 2202–5.
64.
64. Stern JM, Chesnut CH, Bruemmer B, et al. Bone density loss during treatment of chronic GVHD. Bone Marrow Transplant1996;17:395–400.
65.
65. Miller SJ, Simpson J.Medication-nutrient interactions: hypo-phosphatemia associated with sucralfate in the intensive care unit. Nutr Clin Pract1991;6:199–201.
66.
66. Kaplan B, Mujais S.Disorders of renal function and electrolytes. In: Burt RK, Deeg HJ, Lothian ST, et al, eds. On Call in Bone Marrow Transplantation.Austin, TX: RG Landes Company, 1996; 408–24.
67.
67. Lippmann BJ.Fluid and electrolyte management. In: Ewald GA, McKenzie CR, eds. Manual of Therapeutics, 28th ed.Boston, MA: Little, Brown and Company, 1997;43–64.
