Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Biol Blood Marrow Transplant. 2019 May;25(5):981-988. doi: 10.1016/j.bbmt.2019.01.006. Epub 2019 Jan 11.
Markers of inflammatory and nutritional status, such as the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index, Glasgow Prognostic Score, and C-reactive protein-albumin ratio (CAR) has been demonstrated to be associated with poor prognosis in patients with various cancers. Although the relatively low cell dose of a single cord blood unit restricts the indication for cord blood transplantation (CBT) to pediatric and relatively smaller and lighter adult patients, the impact of malnutrition on outcomes after CBT is unclear. We retrospectively analyzed 165 adult patients who underwent myeloablative single-unit CBT in our institute. In multivariate analysis, a higher CONUT score, which is indicative of poor inflammatory and nutritional status, was significantly associated with poor outcomes, including low neutrophil engraftment and development of extensive chronic graft-versus-host disease. A higher CAR, which is also suggestive of poor inflammatory and nutritional status, was significantly associated with poor neutrophil engraftment and higher overall mortality. Body mass index (BMI) was not associated with transplantation outcomes. These data suggest that poor pretransplantation inflammatory and nutritional status might be a more practical parameter than lower BMI, for predicting transplantation outcomes after single CBT for adults.
炎症和营养状态标志物，如控制营养状态（CONUT）评分、预后营养指数、格拉斯哥预后评分和 C 反应蛋白-白蛋白比值（CAR），已被证明与各种癌症患者的不良预后相关。尽管单个脐血细胞剂量相对较低，限制了脐血移植（CBT）的适应证仅限于儿科和相对较小、较轻的成年患者，但营养不良对 CBT 后结局的影响尚不清楚。我们回顾性分析了在我院接受清髓性单单位 CBT 的 165 例成年患者。多变量分析显示，较高的 CONUT 评分提示炎症和营养状态较差，与不良结局显著相关，包括中性粒细胞植入不良和广泛慢性移植物抗宿主病的发展。较高的 CAR 也提示炎症和营养状态较差，与中性粒细胞植入不良和总死亡率较高显著相关。体重指数（BMI）与移植结局无关。这些数据表明，与 BMI 较低相比，移植前较差的炎症和营养状态可能是预测成人单次 CBT 后移植结局的更实用参数。
