| ASPEN99 van der Meij BS, de Graaf P, Wierdsma NJ, Langius JAE, Janssen JJWM, van Leeuwen PAM, et al. Nutritional support in patients with GVHD of the digestive tract: state of the art. Bone Marrow Transplant. 2013;48(4):474-82.
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Malnourished patients unable to absorb/ingest adequate nutrients for 7-14 days
Criteria to initiate PN not specified |
Not mentioned |
Not mentioned |
After stem cell engraftment when adequate EN or oral intake is feasible |
Benefits of a lipid based PN vs. glucose based PN to decrease risk of GVHD
Use of glutamine |
Increased morbidity, more diarrhea, more hyperglycemia, delayed time to engraftment |
|
|
| ESPEN4747 Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M, et al. ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clin Nutr. 2009;28(4):445-54.
|
Start NST if:
- Undernourished
- Inability to eat >60% of nutritional needs for >7 days
PN preferred if increased risk of hemorrhage and infection related to tube placement |
Ambulant patient: 30-35 kcal/kg/day
Bedridden patient: 20-25 kcal/kg/day (recommendations for general oncology patients) |
1.2-2.0 g/kg/day (recommendations for general oncology patients) |
Not mentioned |
Benefits of glutamine and omega 3 |
Not mentioned |
|
|
Italian group
University La Sapienza, Rome22 Muscaritoli M, Grieco G, Capria S, Iori AP, Rossi Fanelli F. Nutritional and metabolic support in patients undergoing bone marrow transplantation. Am J Clin Nutr. 2002;75(2):183-90.
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PN routinely initiated on Day-1 of allo-HSCT and continued for 15-21 days. Oral intake not allowed during this period |
130-150% of basal energy requirements or 30-35 kcal/kg/day |
1.5 g/kg/day |
Not mentioned |
Benefits of a lipid based PN in decreasing risk of acute GVHD use of glutamine |
Not mentioned |
|
|
| FNCLCC1818 Raynard B, Nitenberg G, Gory-Delabaere G, Bourhis JH, Bachmann P, Bensadoun RJ, et al. Summary of the Standards, Options and Recommendations for nutritional support in patients undergoing bone marrow transplantation (2002). Br J Cancer. 2003;89(Suppl. 1):S101-6.
|
NST indicated to malnourished patients (>10% loss of body weight) irrespective of the type of transplant or conditioning
PN if oral/EN intolerance, GI obstruction or severe mucositis |
Non-protein calorie intake of 25-35 kcal/kg/day |
Daily nitrogen intake between 200 and 250 mg/kg |
Oral and/or EN able to provide > 60% of nutritional requirements |
Benefits of a lipid based PN in decreasing risk of acute GVHD use of glutamine |
Not mentioned |
|
|
| Spanish group Univesity La Paz, Madrid66 Martin-Salces M, de Paz R, Canales MA, Mesejo A, Hernandez-Navarro F. Nutritional recommendations in hematopoietic stem cell transplantation. Nutr Burbank Los Angel Cty Calif. 2008;24(7-8):769-75.
|
Start PN if:
- Loss of >10% of initial weight
- BMI <18.5 kg/m2
- Oral intake < 60-70% of required over 3 days |
130-150% of the estimated basal energy requirements, or 30-50 kcal/kg/day |
1.5-2.0 g/kg/day of standard amino acid solution |
Oral diet covers > 50% of daily energy needs |
Benefits of glutamine, antioxidants (selenium, vitamins C and E) and omega 3 |
Catheter-related infections
Atrophy of villi and increase in bacterial translocation |
|
|
| SBNPE4848 Terapia Nutricional no Transplante de Célula Hematopoiética. Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE) e Associação Brasileira de Nutrologia (ABRAN). 2011.
|
Start PN if:
- Severe malnutrition at hospital admission
- 7-10 days of inadequate oral intake
- Weight loss > 10% during treatment |
130-150% of basal energy requirements or 30-35 kcal/kg/day |
1.5 g/kg/day |
Oral intake and/or EN able to provide > 50% of nutritional requirements |
Timing to initiate PN:
- 24-36 h after transplantation
OR
- When oral intake <60-70% of nutritional requirements |
More hyperglycemia, higher risk of infections and positive blood cultures, prolonged hospitalization and need of transfusions |
