Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan; Nutritional Support Team, Sapporo Medical University Hospital, Sapporo, Japan.
Nutritional Support Team, Sapporo Medical University Hospital, Sapporo, Japan; Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Nutrition. 2021 Mar;83:111093. doi: 10.1016/j.nut.2020.111093. Epub 2020 Nov 23.
Intensive nutritional support during allogeneic hematopoietic stem cell transplantation (allo-HSCT) yields improved clinical outcomes. However, the clinical implications of early enteral nutrition (EN) in allo-HSCT remain unclear. This retrospective study was conducted to determine the significance of early EN in individuals who underwent allo-HSCT, and the association between early nutritional intervention and clinical outcomes, including the status of the intestinal microbiome.
Thirty-one participants received EN before conditioning. The intestinal microbiota was examined by meta 16S rRNA gene sequencing of fecal samples.
The median body mass variation was only -0.35 kg on day 60. The probability of 2-y overall survival was 61.1%. The cumulative incidence of treatment-related mortality was 17.4%, and those of acute graft-versus-host disease were 32.3% (grades II-IV) and 3.2% (grades III-IV). Chronic graft-versus-host disease was observed in four participants. Dysbiosis of the intestines and acute graft-versus-host disease occurred simultaneously, and Enterococcus species were abundant.
Our results suggest that early nutritional support can improve the outcomes for individuals who have undergone allo-HSCT and can maintain homeostasis of their intestinal microbiome. Future prospective clinical trials are required to elucidate the role of EN in allo-HSCT and the association between the intestinal microbiome and EN.
异基因造血干细胞移植(allo-HSCT)期间强化营养支持可改善临床结局。然而,allo-HSCT 中早期肠内营养(EN)的临床意义仍不清楚。本回顾性研究旨在确定 allo-HSCT 患者中早期 EN 的意义,以及早期营养干预与临床结局之间的关系,包括肠道微生物组的状态。
31 名参与者在预处理前接受 EN。通过粪便样本的 meta 16S rRNA 基因测序来检测肠道微生物组。
第 60 天的体重中位数变化仅为-0.35kg。2 年总生存率为 61.1%。治疗相关死亡率的累积发生率为 17.4%,急性移植物抗宿主病的累积发生率分别为 32.3%(II-IV 级)和 3.2%(III-IV 级)。4 名参与者发生慢性移植物抗宿主病。肠道菌群失调和急性移植物抗宿主病同时发生,肠球菌属丰富。
我们的结果表明,早期营养支持可以改善 allo-HSCT 患者的结局,并维持其肠道微生物组的平衡。需要进行未来的前瞻性临床试验来阐明 EN 在 allo-HSCT 中的作用以及肠道微生物组与 EN 的关系。