Relationship Between Nutritional Status And Early Clinical Outcome Of Hematopoietic Stem Cell Transplantation

Objective:To evaluate the nutrition status of allogeneic hematopoietic stem cell transplantation(allo-HSCT)patients from pre-treatment to post-transplantation,and to explore the relationship between the changes of nutritional indexes and the early clinical outcome of transplantation.Methods:183 patients who underwent allogeneic hematopoietic stem cell transplantation were included in November 2018 to March 2020 in the first hospital affiliated to Soochow university.Nutrition assessment were done at 4 time points(before pretreatment,before transplantation,14 days after transplantation and 28 days after transplantation).Nutrition assessment including nutrition risk screen 2002(NRS2002),patient generated subjective global assessment(PG-SGA),dietary survey,clinical biochemical indexes,human body composition analysis.To analyze the relationship between abnormal body composition at 28 days after transplantation and clinical outcomes at the early stage of transplantation(within 100 days after hematopoietic stem cell retransfusion),including gastrointestinal mucositis,infection,graft-versus-host disease,Non-recurrent death and Recurrence.Results:1.Nutritional assessmentAll patients with HSCT had nutritional risk,and the incidence of malnutrition gradually increased after preconditioning.The prevalence of malnutrition was 100%according to PG-SGA scale.After pretreatment,the patients ate less food than before.2.Diet conditionAfter pretreatment,the diet was mainly liquid or semi-liquid,and the dietary score was significantly lower before transplantation than 14 days after transplantation and 28 days after transplantation(P<0.001).Abnormal taste associated with eating:self-perceived food without taste and bad food smell were the most obvious before transplantation,and decreased 14 days and 28 days after transplantation(P<0.001);Oral pain,dry mouth and other symptoms were most obvious before transplantation,and improved significantly 28 days after transplantation(P=0.01).Before transplantation,the incidence of gastrointestinal symptoms affecting eating was 56.7%with nausea and vomiting and 35%with diarrhea,which were significantly higher than 14 days and 28 days after transplantation.3.Body composition changeAfter pretreatment to 28 days after transplantation,the body weight,skeletal muscle mass and body cell mass of the patients decreased significantly(P<0.05).Body fat content,body fat percentage and visceral fat content increased gradually after transplantation,these indexes had significant differences 28 days after transplantation(P<0.05).The incidence of low skeletal muscle index(sarcopenia)28 days after transplantation was 13.7%,excess body fat was 61.7%,and abnormal visceral fat was 38.3%.The incidence of hypercholesterolemia was 36.1%,abnormal LDL cholesterol was 33.9%,hypertriglyceridemia was 82.5%and hyperglycemia was 20.8%.4.The relation between nutritional status and early outcomesSarcopenia and sarcopenia obesity are associated with gastrointestinal mucositis acute graft-versus-host disease(aGVHD)and Non-recurrent death.Abnormal of visceral fat is also associated with aGVHD.Conclusion:1.Patients with allo-HSCT have high nutritional risk,and timely nutritional assessment and intervention should be carried out.2.The changes in the composition of hematopoietic stem cell transplantation were characterized by continuous decrease in muscle tissue and increase in adipose tissue,which provided a basis for the implementation of the correct nutritional support program for allo-HSCT patients.3.Sarcopenia and sarcopenia obesity are associated with the incidence of gastrointestinal mucositis and aGVHD.Therefore,it is of great significance to implement timely and correct nutritional support program for patients undergoing HSCT.