Aoyama Takashi, Imataki Osamu, Arai Hidekazu, Kume Tetsuo, Shiozaki Hitomi, Katsumata Naomi, Mori Mariko, Ishide Keiko, Ikeda Takashi
Division of Nutrition, Shizuoka Cancer Center, Naga-izumi, Shizuoka, Japan.
Division of Hematology and Stem Cell Transplantation, Kagawa University Hospital, Miki, Kagawa, Japan.
Med Sci Monit Basic Res. 2018 Feb 5;24:31-39. doi: 10.12659/msmbr.908113.
BACKGROUND The aim of this study was to compare nutrition-related adverse events and clinical outcomes of ifosfamide, carboplatin, and etoposide regimen (ICE therapy) and ranimustine, carboplatin, etoposide, and cyclophosphamide regimen (MCEC therapy) instituted as pretreatment for autologous peripheral blood stem cell transplantation. MATERIAL AND METHODS We enrolled patients who underwent autologous peripheral blood stem cell transplantation between 2007 and 2012. Outcomes were compared between ICE therapy (n=14) and MCEC therapy (n=14) in relation to nutrient balance, engraftment day, and length of hospital stay. In both groups, we compared the timing of nutrition-related adverse events with oral caloric intake, analyzed the correlation between length of hospital stay and duration of parenteral nutrition, and investigated the association between oral caloric intake and the proportion of parenteral nutrition energy in total calorie supply. Five-year survival was compared between the groups. RESULTS Compared with the MCEC group, the ICE group showed significant improvement in oral caloric intake, length of hospital stay, and timing of nutrition-related adverse events and oral calorie intake, but a delay in engraftment. Both groups showed a correlation between duration of parenteral nutrition and length of hospital stay (P=0.0001) and between oral caloric intake (P=0.0017) and parenteral nutrition energy sufficiency rate (r=-0.73, P=0.003; r=-0.76, P=0.002). Five-year survival was not significantly different between the groups (P=0.1355). CONCLUSIONS Our findings suggest that compared with MCEC therapy, ICE therapy improves nutrition-related adverse events and reduces hospital stay, conserving medical resources, with no significant improvement in long-term survival. The nutritional pathway may serve as a tool for objective evaluation of pretreatment for autologous peripheral blood stem cell transplantation.
背景 本研究旨在比较异环磷酰胺、卡铂和依托泊苷方案（ICE疗法）与雷莫司汀、卡铂、依托泊苷和环磷酰胺方案（MCEC疗法）作为自体外周血干细胞移植预处理时的营养相关不良事件和临床结局。材料与方法 我们纳入了2007年至2012年间接受自体外周血干细胞移植的患者。比较了ICE疗法组（n = 14）和MCEC疗法组（n = 14）在营养平衡、植入日和住院时间方面的结局。在两组中，我们比较了营养相关不良事件的发生时间与口服热量摄入，分析了住院时间与肠外营养持续时间之间的相关性，并研究了口服热量摄入与肠外营养能量在总热量供应中所占比例之间的关联。比较了两组的5年生存率。结果 与MCEC组相比，ICE组在口服热量摄入、住院时间、营养相关不良事件的发生时间和口服热量摄入方面有显著改善，但植入延迟。两组均显示肠外营养持续时间与住院时间之间存在相关性（P = 0.0001），口服热量摄入与肠外营养能量充足率之间也存在相关性（r = -0.73，P = 0.003；r = -0.76，P = 0.002）。两组之间的5年生存率无显著差异（P = 0.1355）。结论 我们的研究结果表明，与MCEC疗法相比，ICE疗法改善了营养相关不良事件并缩短了住院时间，节省了医疗资源，但长期生存率无显著改善。营养途径可作为客观评估自体外周血干细胞移植预处理的工具。
