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Better early outcome with enteral rather than parenteral nutrition in children undergoing MAC allo-SCT

F Gonzales1, B Bruno1, M Alarcón Fuentes1

  • 1Univ. Lille, CHU Lille, Hématologie Pédiatrique, Hôpital Jeanne de Flandre, F-59000 Lille, France.

Clinical Nutrition (Edinburgh, Scotland)
|November 4, 2017
PubMed

Insights

Early enteral nutrition (EN) improves outcomes for children undergoing myeloablative conditioning allogeneic stem cell transplantation (allo-SCT). EN reduced mortality, GVHD, and hospital stay compared to parenteral nutrition (PN), suggesting it should be the primary nutritional support.

Area of Science:

  • Pediatric Hematology/Oncology
  • Transplantation Immunology
  • Clinical Nutrition

Background:

  • Nutritional support is critical for pediatric patients undergoing allogeneic stem cell transplantation (allo-SCT) after myeloablative conditioning (MAC).
  • There is no established consensus on the optimal type of nutritional support (enteral vs. parenteral) in this vulnerable population.
  • Early nutritional interventions significantly impact patient recovery and overall outcomes post-transplant.

Purpose of the Study:

  • To compare the efficacy of early enteral nutrition (EN) versus parenteral nutrition (PN) in children undergoing MAC allo-SCT.
  • To evaluate the impact of nutritional support on key clinical outcomes, including mortality, graft-versus-host disease (GVHD), and engraftment.
  • To determine the optimal timing and type of nutritional intervention for pediatric allo-SCT recipients.

Main Methods:

  • Retrospective, multicenter, observational study comparing EN (n=97) and PN (n=97) groups.
  • Patients were matched for important covariates to ensure comparability between groups.
  • Primary endpoint was overall mortality at day 100 post-transplant; secondary endpoints included GVHD, engraftment, and length of stay.

Main Results:

  • The EN group showed significantly lower day 100 overall mortality (1% vs. 13%, p=0.0127) and non-relapse mortality (1% vs. 7%, p=0.066).
  • Acute GVHD grades II-IV (37% vs. 54%, p=0.0127) and gut localization (16% vs. 32%, p=0.0136) were reduced in the EN group.
  • Platelet engraftment was superior in the EN group (97% vs. 80% for ≥20 G/L, p<0.0001), with a shorter hospital stay (28 vs. 52 days, p<0.0001).

Conclusions:

  • Early administration of enteral nutrition is associated with improved outcomes in children undergoing MAC allo-SCT.
  • Parenteral nutrition should be reserved for cases where enteral nutrition is insufficient or not feasible.
  • These findings support EN as the preferred initial nutritional strategy in this patient population.

Keywords:
Bone marrow transplantationGraft versus host diseaseHaematological diseaseMicrobiotaNutritional statusPaediatric

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