Energy expenditure of patients undergoing stem cell transplantation: A systematic review

Patients undergoing haematopoietic stem cell transplantation are at high risk of malnutrition, with limited clinical guidelines available to inform energy provision. This systematic review aimed to synthesize and assess the evidence for energy expenditure of patients undergoing stem cell transplantation with and without Graft-versus-Host-Disease.

A systematic search of PubMed, CINAHL, Embase, Cochrane and Scopus was conducted to include studies published until 20 May 2025. The review utilised the PRISMA framework and the Academy of Nutrition and Dietetics quality criteria checklist. Included studies were those measuring resting energy expenditure or total energy expenditure of patients aged ≥15 undergoing stem cell transplantation. Exclusion criteria were case studies, conference papers, animal studies or non-English language.

Ten studies were eligible and rated as neutral (n = 5) or negative quality (n = 5). High heterogeneity in timepoints, study designs, participants, methodologies, outcomes and energy expenditure unit measures restricted the ability to pool energy expenditure outcome data. Post autologous transplant, energy expenditure remained either relatively stable or increased from baseline. Post allogeneic transplant, energy expenditure was either stable or increased after transplant, but in one study when tested during aplasia, this had declined from baseline. For Graft-versus-Host-Disease, the limited data available indicated equivalent or higher energy expenditure than the control group.

This review highlights the lack of data to guide energy expenditure provision during stem cell transplantation. Nutritional intake and status should be monitored closely during stem cell transplantation and Graft-versus-Host-Disease. Additional high-quality studies with larger sample sizes using validated measurement tools are required.