0
selected
-
1.
Relationship Between Pre-Transplant Nutritional Status and Outcomes of Adults with Acute Myeloid Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation
Orvain, C., Byelykh, M., Othus, M., Sandmaier, B. M., Schoch, G., Davis, C., Appelbaum, F. R., Walter, R. B.
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Pre-transplant nutritional status may impact outcome after allogeneic hematopoietic cell transplantation (HCT). Various simple screening tools have been developed and used to identify patients at risk of malnutrition. However, how best to use these screening tools is unclear, and their accuracy for the prediction of adverse outcomes is unknown. OBJECTIVE To investigate how these different measures contribute to outcome prediction, we examined a large cohort of adults with AML who underwent allogeneic HCT in first or second remission at our institution between April 2006 and May 2021. RESULTS Here, we assessed the prognostic role of the nutrition risk index (NRI), which combines weight loss and serum albumin, in 970 adults with acute myeloid leukemia (AML) in first or second remission who underwent allogeneic HCT between 2006 and 2021 and had usual body weight information available at AML diagnosis or relapse and before HCT. A low NRI at the time of conditioning for HCT was associated with higher non-relapse mortality (NRM, HR=0.97 [0.95-0.98], P<0.001) and relapse risk (hazard ratio [HR]=0.98 [95% confidence interval: 0.96-0.99], P<0.001) and decreased relapse-free survival (RFS, HR=0.97 [0.96-0.98], P<0.001) and overall survival (OS, HR=0.97 [0.96-0.98], P<0.001), as were pre-HCT albumin levels. After multivariable adjustment, the NRI but not weight loss alone was associated with outcome. The predictive ability of the NRI was overall relatively low and comparable to serum albumin, with C-statistics not exceeding 0.59. CONCLUSION Together, our data indicate that pre-HCT levels of serum albumin, an acute-phase protein recognized to reflect more the severity of the inflammatory response than poor nutritional status, but not weight loss, are independently associated with post-HCT outcomes in AML patients.
-
2.
Nutritional Status at Diagnosis and Pre-transplant Weight Loss Impact Outcomes of Acute Myeloid Leukemia Patients Following Allogeneic Stem Cell Transplantation
Brauer, D., Backhaus, D., Pointner, R., Vucinic, V., Niederwieser, D., Platzbecker, U., Schwind, S., Jentzsch, M.
HemaSphere. 2021;5(3):e532
Abstract
The nutritional status at diagnosis, as well as weight loss during chemotherapy, are important factors for morbidity and mortality in cancer patients. They might also influence outcomes in patients with acute myeloid leukemia (AML) receiving allogeneic hematopoietic stem cell transplantation (HSCT). We evaluated the body mass index (BMI) at diagnosis, prior to HSCT, and the BMI difference (?BMI?=?BMI(HSCT)-BMI(diagnosis)) in 662 AML patients undergoing allogeneic HSCT. Patients being obese at AML diagnosis had significantly higher nonrelapse mortality (NRM) and shorter overall survival (OS) after HSCT, but no distinct cumulative incidence of relapse than nonobese patients. Weight loss during chemotherapy (?BMI > -2) was a strong predictor for higher NRM and shorter OS in univariate and multivariate analyses. These results were observed across all European LeukemiaNet (ELN) 2017 risk groups but especially in patients with favorable or intermediate ELN2017 risk and patients transplanted in morphologic complete remission. Only in patients being obese at AML diagnosis, weight loss did not result in adverse outcomes. ?BMI > -2 represents a strong, independent, and modifiable risk factor for AML patients treated with HSCT. Nutritional monitoring and supplementation during disease course might improve patients' outcomes.
-
3.
Prediction of clinical outcome by controlling nutritional status (CONUT) before allogeneic hematopoietic stem cell transplantation in myeloid malignancies
Araie, H., Kawaguchi, Y., Okabe, M., Lee, Y., Ohbiki, M., Osaki, M., Goto, M., Goto, T., Morishita, T., Ozawa, Y., et al
International journal of hematology. 2019
Abstract
Malnutrition before allogeneic hematopoietic cell transplantation (allo-HCT) is associated with poor clinical outcomes. Herein, we evaluated the predictive value of controlling nutritional status (CONUT) in patients undergoing allo-HCT for myeloid malignancies. We retrospectively analyzed 200 patients with myeloid malignancies who underwent allo-HCT for the first time. We evaluated CONUT before the initiation of conditioning and compared malnourished patients (poor CONUT, n = 56) with non-malnourished patients (normal CONUT, n = 144). The cumulative incidence of non-relapse mortality within 100 days (early NRM) was significantly higher in the poor CONUT group than in the normal CONUT group [21.4% (95% CI: 11.8-33.0%) vs. 9.7% (95% CI: 5.6-15.2%); P = 0.025]. In multivariate analysis, poor CONUT was an independent and significant risk factor for early NRM [HR: 2.2 (95% CI: 1.0-4.7); P = 0.048]. The overall 1-year survival rate was significantly lower in the poor CONUT group than in the normal CONUT group [53.3% (95% CI: 39.4-65.4%) vs. 71.0% (95% CI: 62.7-77.7%); P = 0.005]. These findings suggest that CONUT before allo-HCT is a useful predictor of poor outcomes in patients with myeloid malignancies.
-
4.
Geriatric nutritional risk index (GNRI) just before allogeneic hematopoietic stem cell transplantation predicts transplant outcomes in patients older than 50 years with acute myeloid leukemia in complete remission
Konishi, T., Doki, N., Kishida, Y., Nagata, A., Yamada, Y., Kaito, S., Kurosawa, S., Yoshifuji, K., Shirane, S., Uchida, T., et al
Annals of hematology. 2019
-
5.
Protein blend ingestion before allogeneic stem cell transplantation improves protein-energy malnutrition in patients with leukemia
Ren, G., Zhang, J., Li, M., Yi, S., Xie, J., Zhang, H., Wang, J.
Nutrition Research. 2017
Abstract
Severe protein-energy malnutrition (PEM) and skeletal muscle wasting are commonly observed in patients with acute leukemia. Recently, the ingestion of a soy-whey protein blend has been shown to promote muscle protein synthesis (MPS). Thus, we tested the hypothesis that the ingestion of a soy-whey blended protein (BP) may improve the PEM status and muscle mass in acute leukemia patients. In total, 24 patients from the same treatment group were randomly assigned to the natural diet plus soy-whey blended protein (BP) group and the natural diet only (ND) group. Our data showed that protein and energy intake decreased significantly (P < .05) after transplantation in both groups. In the absence of the BP intervention, dramatic decreases in muscle-related indicators (i.e., anthropometric variables, muscle strength and serum protein) were observed in the majority (>50%) of the patients. However, 66% of the patients who ingested the BP before transplantation showed obvious increases in arm muscle area. The gripping power value (post-pre or post-baseline) was significantly higher in the BP group than in the ND group (P < .05). The ingestion of the BP also increased the levels of serum albumin, globulin and serum total protein to different extents. Notably, the average time to stem cell engraftment was significantly shorter for patients in the BP group (12.2 +/- 2.0 days) than for patients in the ND group (15.1 +/- 2.9 days). Collectively, our data supported that soy-whey protein can improve PEM status and muscle mass in leukemia patients. Copyright © 2017 Elsevier Inc. All rights reserved.
-
6.
Association of Nutritional Parameters with Clinical Outcomes in Patients with Acute Myeloid Leukemia Undergoing Haematopoietic Stem Cell Transplantation
Baumgartner, A., Zueger, N., Bargetzi, A., Medinger, M., Passweg, J. R., Stanga, Z., Mueller, B., Bargetzi, M., Schuetz, P.
Annals of Nutrition & Metabolism. 2016;69(2):89-98
-
-
Free full text
-
Abstract
INTRODUCTION In acute myeloid leukemia (AML) patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT), there is uncertainty about the extent of influence nutritional parameters have on clinical outcomes. In this study, we investigated the association between initial body mass index (BMI) and weight loss during HSCT on clinical outcomes in a well-characterised cohort of AML patients. METHODS We analysed data of the Basel stem-cell transplantation registry ('KMT Kohorte') including all patients with AML undergoing first allogeneic HSCT from January 2003 to January 2014. We used multivariable regression models adjusted for prognostic indicators (European Group for Blood and Marrow Transplantation risk score and cytogenetics). RESULTS Mortality in the 156 AML patients (46% female, mean age 46 years) over the 10 years of follow-up was 57%. Compared to patients with a baseline BMI (kg/m2) of 20-25, a low BMI <20 was associated with higher long-term mortality (70 vs. 49%, adjusted hazard ratio 1.97, 95% CI 1.04-3.71, p = 0.036). A more pronounced weight loss during HSCT (>7 vs. <2%) was associated with higher risk for bacterial infections (52 vs. 28%, OR 2.8, 95% CI 0.96-8.18, p = 0.059) and fungal infections (48 vs. 23%, OR 3.37, 95% CI 1.11-10.19, p = 0.032), and longer hospital stays (64 vs. 38 days, adjusted mean difference 25.6 days (15.7-35.5), p < 0.001). CONCLUSION In patients with AML, low initial BMI and more pronounced weight loss during HSCT are strong prognostic indicators associated with lower survival and worse disease outcomes. Intervention research is needed to investigate whether nutritional therapy can reverse these associations.Copyright © 2016 S. Karger AG, Basel.