Nutritional interventions in patients with graft-versus-host disease

This review aims to highlight the benefits of nutrition before and during graft-versus-host disease (GvHD) and the promising precision medicine approach that should be offered to prevent and mitigate GvHD.

The intestinal damage induced by preconditioning/conditioning chemotherapies is the main trigger of GvHD. Impaired nutritional status and decreased plasma citrulline level, which is the most sensitive biomarker of intestinal barrier health, predict the occurrence of acute GvHD after allogeneic hematopoietic cell transplantation (allo-HCT). Optimal oral and/or enteral nutrition and a lack of vitamin D deficiency limit this intestinal damage. As intestinal dysbiosis plays an important role in GvHD, probiotics and prebiotics supplementation could be a promising therapy. Diverting enterostomy combined with parenteral nutrition saves the lives of patients with severe steroid-refractory gastrointestinal GvHD.

Regardless of age, healthy nutritional status and a healthy gut barrier are protective factors against GvHD in patients undergoing allo-HCT, and above all, these are closely dependent on adequate oral and/or enteral intake. Therefore, maintaining gut barrier integrity through adequate oral nutrition before allo-SCT and early first-line enteral nutrition after allo-HCT are of critical importance, not forgetting vitamin D supplementation. In the future, probiotics and prebiotics are expected to play a growing role for replenishing the commensal microbiota given the impact of gut dysbiosis on GvHD. Parenteral nutrition remains the only nutritional support that can be used in the event of severe gastrointestinal GvHD.