Curr Opin Clin Nutr Metab Care. 2018 May;21(3):152-158. doi: 10.1097/MCO.0000000000000461.
Malnutrition before and during hematopoietic stem cell transplantation (HSCT) is an independent risk factor for mortality in patients undergoing hematopoietic stem cell transplantation. Yet, optimal use of nutritional support to improve outcomes remains controversial. Our aim was to do an up-to-date literature review regarding nutritional therapy in allogeneic HSCT, the neutropenic diet and the use of immunonutrients.
Several observational studies find malnutrition to be associated with poor outcome, increased complications and lower overall survival. There are, however, few interventional trials proving the benefits of nutritional therapy in this population compared with no nutritional treatment. Regarding routes of treatment, studies suggested that parenteral nutrition is associated with higher risk for complications compared with enteral nutrition. Whether the use of specific formulas, such as immunonutrition, has a beneficial effect on clinical outcome is not established yet. Strict use of neutropenic diets did not show a reduction in infection risk and clinical outcome, and can no longer be recommended.
Our updated search confirms that malnutrition is a strong negative predictor for outcome, yet optimal use of nutritional interventions to prevent or treat malnutrition remains ill-defined. There is need for larger randomized trials to better address these issues in the future.
造血干细胞移植（HSCT）前和移植期间的营养不良是接受造血干细胞移植患者死亡的独立危险因素。然而，最佳使用营养支持以改善结局仍存在争议。我们的目的是对异基因 HSCT 中的营养治疗、中性粒细胞减少症饮食和免疫营养素的使用进行最新的文献综述。
几项观察性研究发现，营养不良与不良结局、并发症增加和总生存率降低相关。然而，与无营养治疗相比，很少有干预性试验证明营养治疗在该人群中的益处。关于治疗途径，研究表明，与肠内营养相比，肠外营养与更高的并发症风险相关。特定配方（如免疫营养）的使用是否对临床结局有有益影响尚未确定。严格使用中性粒细胞减少症饮食并没有显示出降低感染风险和临床结局的作用，因此不再推荐使用。
我们更新的搜索结果证实，营养不良是结局的强烈负预测因素，但最佳使用营养干预以预防或治疗营养不良仍未明确。未来需要更大规模的随机试验来更好地解决这些问题。
