Route of Nutrition Impacts Outcomes After Autologous Stem Cell Transplant for High-Risk Neuroblastoma

High-risk neuroblastoma treatment includes myeloablative conditioning with subsequent autologous stem cell transplant (ASCT), which can lead to malnutrition, pancytopenia, mucositis, and infections. The impact of enteral versus parenteral nutrition on outcomes in this population is understudied.

The primary objective was to determine whether nutritional outcomes differ in high-risk neuroblastoma patients undergoing ASCT when supported with enteral, parenteral, or combined enteral-parenteral nutrition. A secondary objective was to evaluate potential differences in adverse events, length of stay, mortality, time to engraftment, and transfusion needs.

A retrospective chart review was performed for 36 transplants in 27 patients with high-risk neuroblastoma at American Family Children's Hospital between 2011 and 2021. Primary endpoints were nutritional parameters consisting of height, weight, body mass index (BMI), BMI z-score, and feeding type. Secondary endpoints included clinical outcomes such as length of stay, mortality, time to engraftment, and transfusion needs. Data were analyzed using descriptive statistics and generalized linear mixed effects models.

Patients were grouped by nutrition: enteral (n = 6), parenteral (n = 7), and combined (n = 14). Parenteral nutrition was associated with greater weight gain (+0.8 kg, p = 0.0006) and BMI z-scores (p = 0.0003). Enteral nutrition was linked to shorter durations of diarrhea (5.8 vs. 20.8 days, p = 0.0001) and vomiting (6.2 vs. 12.7 days, p = 0.0075), lower mucositis severity (2.1 vs. 4.5, p = 0.0022), faster platelet engraftment (9.4 vs. 25.8 days, p = 0.0001), and fewer packed red blood cell transfusions (2.2 vs. 6.2, p = 0.0023). No differences in length of stay or mortality were observed.

Parenteral nutrition during ASCT improved nutritional outcomes, whereas enteral nutrition reduced complications, accelerated platelet engraftment, and decreased transfusion needs.