Hirose Erika Yuri, de Molla Vinicius Campos, Gonçalves Matheus Vescovi, Pereira André Domingues, Szor Roberta Shcolnik, da Fonseca Ana Rita Brito Medeiro, Fatobene Giancarlo, Serpa Mariana Gomes, Xavier Erick Menezes, Tucunduva Luciana, Rocha Vanderson, Novis Yana, Arrais-Rodrigues Celso
Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil.
Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil.
Clin Nutr ESPEN. 2019 Oct;33:213-219. doi: 10.1016/j.clnesp.2019.05.005. Epub 2019 Jun 11.
Malnutrition is a common finding in allogeneic hematopoietic stem cell transplantation (alloHSCT) patients, and there is some evidence that malnutrition might negatively affect the transplant outcomes.
We performed a retrospective study with 148 patients aged 18-75 years, who underwent alloHSCT between 2011 and 2017. Patients were classified according to the body mass index (BMI) and the Subjective Global Assessment (SGA). The SGA was assessed on the day of hospitalization for the transplant, and classifies patients into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished).
The SGA classified 49 (33%) patients as well-nourished, 54 (37%) as moderately malnourished, and 45 (30%) as severely malnourished. SGA-C was also associated with severe acute graft versus host disease (aGVHD) with a cumulative incidence (CI) of 31% vs. a CI of 14% for combined well-nourished or moderately malnourished group (SGA-A or -B, P = 0.017). In multivariate analysis, SGA-C compared to SGA-A or -B, remained as an independent risk factor for aGVHD (hazard ratio - HR 1.68, 95% confidence interval - 95% CI 1.02-2.74), and nonrelapse mortality (NRM - HR 3.63, 95% CI 1.76-7.46), worse progression free survival (HR 2.12, 95% CI 1.25-3.60), and worse overall survival (HR 3.27, 95% CI 1.90-5.64).
Malnutrition increases the risk of aGVHD and NRM and has a negative impact on survival.
营养不良在异基因造血干细胞移植（alloHSCT）患者中很常见，并且有证据表明营养不良可能对移植结果产生负面影响。
我们对148例年龄在18至75岁之间、于2011年至2017年间接受alloHSCT的患者进行了一项回顾性研究。根据体重指数（BMI）和主观全面评定法（SGA）对患者进行分类。在移植住院当天进行SGA评定，并将患者分为三组：A组（营养良好）、B组（中度营养不良）和C组（重度营养不良）。
SGA将49例（33%）患者评定为营养良好，54例（37%）为中度营养不良，45例（30%）为重度营养不良。SGA-C组也与严重急性移植物抗宿主病（aGVHD）相关，累积发病率（CI）为31%，而营养良好或中度营养不良合并组（SGA-A或-B）的CI为14%（P = 0.017）。在多变量分析中，与SGA-A或-B相比，SGA-C仍然是aGVHD的独立危险因素（风险比-HR 1.68，95%置信区间-95%CI 1.02-2.74），以及非复发死亡率（NRM-HR 3.63，95%CI 1.76-7.46）、无进展生存期更差（HR 2.12，95%CI 1.25-3.60）和总生存期更差（HR 3.27，95%CI 1.90-5.64）。
营养不良会增加aGVHD和NRM的风险，并对生存产生负面影响。
