Department of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Aichi, Japan.
Department of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Aichi, Japan.
Biol Blood Marrow Transplant. 2019 Nov;25(11):2287-2296. doi: 10.1016/j.bbmt.2019.07.002. Epub 2019 Jul 5.
Nutritional status is an important component of cancer care, and malnutrition itself can cause death in 10% to 20% of cancer patients. A nutritional risk index (NRI) is a useful tool for nutritional assessment of cancer patients. This study aimed to evaluate the impact of pretransplant NRI values on outcomes of allogeneic hematopoietic cell transplantation (allo-HSCT). One hundred sixty patients who underwent allo-HSCT between January 2008 and July 2017 at Konan Kosei Hospital were included in this single-center, retrospective analysis. NRI was calculated at the beginning of the conditioning regimen. The patients were divided into high NRI (NRI ≥ 97.5) and low NRI (NRI < 97.5) groups, and overall survival (OS), nonrelapse mortality (NRM), and cumulative incidences of acute and chronic graft-versus-host disease (GVHD) were evaluated. Two-year OS rates were 76% (95% confidence interval [CI], 63% to 83%) and 50.4% (95% CI, 38% to 62%) in the high NRI and low NRI groups, respectively (P < .001). One-year cumulative incidences of NRM were 7.9% (95% CI, 3.5% to 15%) and 23% (95% CI, 14% to 33%; P = .014) and 2-year cumulative relapse rates were 17% (95% CI, 10% to 26%) and 32% (95% CI, 21% to 43%; P = .10) in the high NRI and low NRI groups, respectively. The multivariate analysis indicated low NRI was a significant risk factor for OS and NRM. Conversely, high NRI was associated with increased incidences of grades II to IV acute GVHD and chronic GVHD. Additionally, the subgroup analysis according to stem cell source revealed a significant benefit of higher NRI on survival only in umbilical cord blood recipients. Overall, these results suggest that pretransplant NRI might predict OS and NRM after allo-HSCT.
营养状况是癌症治疗的一个重要组成部分，营养不良本身可导致 10%20%的癌症患者死亡。营养风险指数（NRI）是评估癌症患者营养状况的有用工具。本研究旨在评估移植前 NRI 值对异基因造血细胞移植（allo-HSCT）结局的影响。本单中心回顾性分析纳入了 2008 年 1 月至 2017 年 7 月在日本神户圣和医院接受 allo-HSCT 的 160 例患者。在预处理方案开始时计算 NRI。将患者分为高 NRI（NRI≥97.5）和低 NRI（NRI＜97.5）组，评估总生存（OS）、非复发死亡率（NRM）以及急性和慢性移植物抗宿主病（GVHD）的累积发生率。高 NRI 和低 NRI 组的 2 年 OS 率分别为 76%（95%CI，63%83%）和 50.4%（95%CI，38%62%）（P＜0.001）。高 NRI 和低 NRI 组的 1 年 NRM 累积发生率分别为 7.9%（95%CI，3.5%15%）和 23%（95%CI，14%33%；P=0.014），2 年累积复发率分别为 17%（95%CI，10%26%）和 32%（95%CI，21%~43%；P=0.10）。多变量分析表明，低 NRI 是 OS 和 NRM 的显著危险因素。相反，高 NRI 与 II 至 IV 级急性 GVHD 和慢性 GVHD 的发生率增加有关。此外，根据干细胞来源的亚组分析，仅在脐带血受者中，较高的 NRI 与生存获益相关。总体而言，这些结果表明，移植前 NRI 可能预测 allo-HSCT 后的 OS 和 NRM。
