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dc.contributor.authorBeckerson, J
dc.contributor.authorSzydlo, RM
dc.contributor.authorHickson, Mary
dc.contributor.authorMactier, CE
dc.contributor.authorInnes, AJ
dc.contributor.authorGabriel, IH
dc.contributor.authorPalanicawandar, R
dc.contributor.authorKanfer, EJ
dc.contributor.authorMacdonald, DH
dc.contributor.authorMilojkovic, D
dc.contributor.authorRahemtulla, A
dc.contributor.authorChaidos, A
dc.contributor.authorKaradimitris, A
dc.contributor.authorOlavarria, E
dc.contributor.authorApperley, JF
dc.contributor.authorPavlu, J
dc.date.accessioned2018-04-26T17:18:31Z
dc.date.issued2018-03-28
dc.identifier.issn0261-5614
dc.identifier.issn1532-1983
dc.identifier.urihttp://hdl.handle.net/10026.1/11364
dc.description.abstract

BACKGROUND: Allogeneic haematopoietic cell transplantation (HCT) is often associated with poor oral intake due to painful mucositis and gastrointestinal sequalae that occur following a preparative regimen of intensive chemotherapy and/or total body radiation. Although attractive to assume that optimal nutrition improves HCT outcomes, there are limited data to support this. It is also unclear whether artificial nutrition support should be provided as enteral tube feeding or parenteral nutrition (PN). METHODS: We analysed day-100 non-relapse mortality (NRM), incidence of acute graft-versus-host disease (GvHD), acute gastrointestinal GvHD, 5-year survival and GvHD-free/relapse-free survival (GRFS) according to both route and adequacy of nutritional intake prior to neutrophil engraftment, together with other known prognostic factors, in a retrospective cohort of 484 patients who underwent allogeneic HCT for haematologic malignancy between 2000 and 2014. RESULTS: Multivariate analyses showed increased NRM with inadequate nutrition (hazard ratio (HR) 4.1; 95% confidence interval (CI) 2.2-7.2) and adequate PN (HR 2.9; 95% CI 1.6-5.4) compared to adequate enteral nutrition (EN) both P < .001. There were increased incidences of gastrointestinal GvHD of any stage and all GvHD ≥ grade 2 in patients who received PN (odds ratio (OR) 2.0; 95% CI 1.2-3.3; P = .006, and OR 1.8; 95% CI 1.1-3.0; P = .018, respectively), compared to adequate EN. Patients who received adequate PN and inadequate nutrition also had reduced probabilities of survival and GRFS at 5 years. CONCLUSION: Adequate EN during the early transplantation course is associated with reduced NRM, improved survival and GRFS at 5 years. Furthermore, adequate EN is associated with lower incidence of overall and gut acute GvHD than PN, perhaps because of its ability to maintain mucosal integrity, modulate the immune response to intensive chemo/radiotherapy and support the gastrointestinal tract environment, including gut microflora.

dc.format.extent738-744
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoen
dc.publisherElsevier
dc.subjectAllogeneic stem cell transplant
dc.subjectArtificial nutrition support
dc.subjectEnteral nutrition
dc.subjectGraft-versus-host-disease
dc.subjectHaematologic malignancy
dc.subjectNon-relapse mortality
dc.subjectParenteral nutrition
dc.subjectSurvival
dc.titleImpact of route and adequacy of nutritional intake on outcomes of allogeneic haematopoietic cell transplantation for haematologic malignancies.
dc.typejournal-article
dc.typeJournal Article
dc.typeResearch Support, Non-U.S. Gov't
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/29650256
plymouth.issue2
plymouth.volume38
plymouth.publication-statusPublished
plymouth.journalClinical Nutrition
dc.identifier.doi10.1016/j.clnu.2018.03.008
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/School of Health Professions
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Plymouth Institute of Health and Care Research (PIHR)
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeEngland
dcterms.dateAccepted2018-03-11
dc.rights.embargodate2019-3-28
dc.identifier.eissn1532-1983
dc.rights.embargoperiod12 months
rioxxterms.versionofrecord10.1016/j.clnu.2018.03.008
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/under-embargo-all-rights-reserved
rioxxterms.licenseref.startdate2018-03-28
rioxxterms.typeJournal Article/Review


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