Development of A Novel Scoring Index to Quantify the Need for Nutritional Support Interventions During Stem Cell Transplant and Gene Therapy in Children.

BACKGROUND

Paediatric patients undergoing stem cell and gene therapy frequently experience nutritional challenges. Although nutritional status is known to correlate with outcomes, there is no scoring index to quantify the intensity and duration of dietetic interventions in children. We developed a nutritional intensity score that assigns weighted values to different nutritional support strategies that reflects both intervention type and duration over the first 100 days post-transplant.

METHODS

We retrospectively analysed 131 paediatric patients after transplant or gene therapy. Nutritional interventions were categorised into five levels: routine dietetic review (1 point), oral nutritional support (2 points), enteral nutritional support (4 points), parenteral nutritional (PN) support (6 points), and bespoke PN support (7 points). The cumulative nutritional intensity score was calculated by multiplying the intervention points by the duration (in days) and summing across all interventions. Subgroup analyses compared median area under the curve (AUC) values in different groups. A further multivariate logistic regression was employed to assess predictors of ≥ PN need at Day 100 within the allogeneic group.

RESULTS

Nutritional intensity varied with different treatment modalities. Chimeric Antigen Receptor T-cell (CAR-T) patients showed notably lower median nutritional intensity score (53.0, 95% CI: 30-117) relative to allogeneic (326.0, 95% CI: 282-404) or stem cell gene therapy (124.5, 95% CI: 56-182, p < 0.05) recipients. Within the allogeneic group (n = 109), patients with malignant diseases had a median nutritional intensity score of 444.0 (95% CI: 350.0-466.0) compared to 261.5 (95% CI: 224.0, 322.0, p < 0.01) in those with nonmalignant conditions. Those receiving total body irradiation (TBI) had higher median nutritional intensity score values (476.0, 95% CI: 317-543) than those without TBI (302.0, 95% CI: 244-386; p < 0.01). In the multivariate analysis, higher nutritional intensity score, malignant disease status, and TBI were significant predictors of ≥ PN requirement at Day 100.

CONCLUSION

Our nutritional intensity score reflects the cumulative burden of nutritional interventions in paediatric patients, and will inform patient and service planning. Future prospective studies are required to validate its predictive value.