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Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 137-141

Altered oral intake during hematopoietic stem cell transplantation: Patterns and countermeasures

1 Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Correspondence Address:
Dr. Suvir Singh
Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College, Ludhiana, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_173_20

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Introduction: Hospitalization for stem cell transplantation leads to reduced oral intake, often requiring parenteral nutrition (PN). Preserving enteral nutrition sustains gut mucosa and microbiota and potentially reduces long-term complications. We provide a short report on patterns of altered dietary intake in stem cell transplant recipients and simple measures that can be taken to mitigate the same. Methods: Patients undergoing autologous and allogeneic stem cell transplantation over an 11 month period were included. Baseline calorie and protein intake was calculated according to the National Institute of Nutrition (India) guidelines. Steps to maintain oral intake included: patient education pretransplant, allowance of home food and packaged food (cookies/chocolates), shift to semisolid or liquid diet, and symptomatic local analgesia for all patients with mucositis. Results: A total of 16 patients were included in the analysis, (male:female = 10:6), with a median age of 43 years (range, 6–67). Median body mass index at baseline was 22.5 kg/m2 (range, 11.9–31.8 kg/m2). Median calorie intake at baseline was 26.8 kcal/kg/day (range, 18–51) and protein intake was 0.47 g/kg/day (range 0.19–0.87). During the course of treatment, maximum grade of mucositis was grade III in 9 and grade II in seven patients. The median caloric deficit from baseline at lowest intake was -79% (range, +11 to − 96%), with the nadir occurring by median day 6.5 (range,-1–12). At the time of discharge, the median oral intake was 70% of baseline (range, −1.2% to + 175%). Most patients had a median of − 4.3% (range, −15% to + 0.4%) of weight loss at discharge. No patient required PN during admission. One patient died as a result of regimen-related toxicity. Conclusions: Patients undergoing stem cell transplantation demonstrated significantly low oral intake at admission which further significantly reduced over the course of hospitalization. Pretransplant optimization of calorie intake, patient education, dietary modification, and in-hospital symptomatic control along with daily monitoring of calorie intake is essential so that reduction can be picked up early and corrective actions are taken.

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