CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, EA7283, CIC501, F-63000 Clermont-Ferrand, France.
CHU Clermont-Ferrand, Service Nutrition Clinique, F-63000 Clermont-Ferrand, France.
Clin Nutr. 2018 Apr;37(2):739-745. doi: 10.1016/j.clnu.2017.03.016. Epub 2017 Mar 28.
Malnutrition is common after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and is a well-known prognostic factor for survival. The nutritional status of patients in a long term after allo-HSCT is less well documented. The main objective of this study was to evaluate the prevalence of malnutrition in adult patients who underwent allo-HSCT more than one year ago. Secondary objectives were to assess body composition, muscle strength, and factors associated with malnutrition.
PATIENTS & METHODS: All allo-HSCT patients admitted into the University Hospital of Clermont-Ferrand between 1st January 1985 and 31st December 2012 were screened. Clinical and biological nutritional assessments included anthropometric measurements, serum nutritional proteins, body composition assessed by bioelectrical impedance, and upper-limb muscle strength (MS) measured by dynamometry. Hematological and nutritional data during and after hospital stay for allo-HSCT were retrospectively collected.
Eighty four allo-HSCT patients (52% men; mean age 54.4 ± 12.5 years) were enrolled. Average follow-up after allo-HSCT was 56.4 ± 47.5 months. Prevalence of malnutrition at the end of follow-up was 20%. Compared to well-nourished patients (WN group), undernourished patients (UN group) at the end of follow-up were significantly more likely to be undernourished (50% vs. 21%, p = 0.04) at hospital admission, and to have a Nutritional Risk Index of <97.5 (47% vs. 20%, p = 0.004). Compared to a reference population, mid-arm muscle circumference and MS were significantly more likely to be decreased in the UN group than in the WN group (35.3% vs. 8.9%, p = 0.017; 24% vs. 3%, p = 0.005, respectively); fat-free mass index and appendicular skeletal muscle mass index were decreased in 30.5% and 36.6% of all patients, respectively, with no difference between UN and WN groups. Chronic graft-versus-host disease was more frequent, although not significantly in the UN group (76% vs. 52%, p = 0.071). In multivariate analyses, the presence of malnutrition at hospital admission for allo-HSCT trended towards an increased risk of longer-term malnutrition (OR = 3.60 [0.95; 13.67], p = 0.06).
Malnutrition is a frequent consequence of allo-HSCT, and may occur several months or years after allo-HSCT, particularly if malnutrition existed before allo-HSCT. Our findings support the need for specialized nutritional care for both before and after allo-HSCT. Furthermore, assessment of muscle mass may be a pertinent parameter of malnutrition in this instance.
异基因造血干细胞移植（allo-HSCT）后常发生营养不良，且是生存的一个明确预后因素。 allo-HSCT 后长期患者的营养状况记录较少。本研究的主要目的是评估 allo-HSCT 一年多的成年患者营养不良的发生率。次要目标是评估身体成分、肌肉力量和与营养不良相关的因素。
筛选了 1985 年 1 月 1 日至 2012 年 12 月 31 日期间入住克莱蒙费朗大学医院的所有 allo-HSCT 患者。临床和生物学营养评估包括人体测量学测量、血清营养蛋白、生物电阻抗评估的身体成分和握力计测量的上肢肌肉力量（MS）。回顾性收集 allo-HSCT 期间和之后住院的血液学和营养数据。
共纳入 84 例 allo-HSCT 患者（52%为男性；平均年龄 54.4 ± 12.5 岁）。 allo-HSCT 后平均随访 56.4 ± 47.5 个月。随访结束时营养不良的发生率为 20%。与营养良好的患者（WN 组）相比，营养不良的患者（UN 组）在随访结束时在入院时明显更容易出现营养不良（50% vs. 21%，p=0.04），且营养风险指数<97.5（47% vs. 20%，p=0.004）。与参考人群相比，UN 组的上臂中部肌肉周长和 MS 明显更有可能降低（35.3% vs. 8.9%，p=0.017；24% vs. 3%，p=0.005）；所有患者的无脂肪质量指数和四肢骨骼肌质量指数分别降低了 30.5%和 36.6%，但 UN 组和 WN 组之间无差异。慢性移植物抗宿主病在 UN 组更常见，尽管差异无统计学意义（76% vs. 52%，p=0.071）。在多变量分析中，allo-HSCT 入院时存在营养不良与长期营养不良的风险增加趋势相关（OR=3.60[0.95；13.67]，p=0.06）。
营养不良是 allo-HSCT 的常见后果，尤其是在 allo-HSCT 之前存在营养不良的情况下，可能在 allo-HSCT 后数月或数年发生。我们的研究结果支持 allo-HSCT 前后都需要进行专门的营养护理。此外，在此情况下，肌肉量的评估可能是营养不良的一个恰当参数。
