Assessing the impact of nutritional status at allogeneic stem cell transplantation on clinical outcomes

Nutritional status at allogeneic hematopoietic cell transplantation (HCT) can significantly impact outcomes, but conflicting results are reported.

We investigate the role of nutritional status on HCT outcomes in 158 patients, including diabetes, body mass index (BMI), nutritional risk index (NRI) and the patient-generated subjective global assessment (PG-SGA).

PG-SGA was scored as A (well nourished) in 52%, B (risk of malnutrition or moderate malnutrition) in 44% and C (severely malnourished) in 4%. NRI was mild in 14 (9%), moderate in 33 (21%) and severe in 4 (3%) patients. Oral nutritional support and total parenteral nutrition was used during hospitalization in 86% and 36% patients. The cumulative incidence of grade II-IV acute graft-versus-host disease (GvHD) at 100 days was 20% (95% CI 14-27%). At 30 months, chronic GvHD was 17% (95% CI 12-24%), non-relapse mortality (NRM) was 25% (95% CI 19-33%) and relapse incidence (RI) was 24% (95% CI 18-32%). Overall survival and progression-free survival were 57% (95% CI 49-64%) and 50% (95% CI 42-58%) at 30 months. Patients with a median BMI above the median (median BMI = 25.87 kg/m2) had a lower risk of both acute (HR 0.42, 95%CI 0.12-0.92, p = 0.03) and chronic (HR 0.42, 95%CI 0.19-0.90, p = 0.02) GvHD in multivariate analysis. No statistical differences were found according to PG-SGA and NRI.

Our findings highlight the critical role of pre-transplant metabolic evaluation, personalized nutritional support, and optimal glycemic regulation in HCT care. Further large-scale studies are required to determine the association between nutritional status and HCT outcomes.