Journal de nutrition clinique et de métabolisme

Nutritional Risk and Risk of Mucositis in Patients Treated with HDT Prior to Stem Cell Transplantation

Lotte Drustrup and Mette Holst

Mucositis is one of the most significant side effects reported in patients receiving high-dose chemotherapy (HDT), either BEAM (a combination therapy) or Melphalal prior to stem cell transplantation due to hematology disease. Mucositis induces pain, diarrhea and reduced food intake in different degrees. This study investigated incidence of mucositis, nutritional risk by NRS (2002 screening), and artificial nutritional therapy in HDT patients. Methods: A retrospective observational cohort included all adult patients treated with HDT prior to stem cell transplantation due to lymphoma or multiple myeloma at Aalborg University Hospital during 20 months. Data was extracted from patient records, and followed patients during the 21-day treatment. Results: A high incidence of mucositis was seen (66%), with highest occurrence in the BEAM population (43%) (p=0.02). The prevalence of nutritional risk increased in both groups from overall 48% before treatment, to overall 92% during treatment (p=0.47), and 41% were treated with EN or PN. An elevation of sodium (p<0.001) as well as potassium (K) (p=0.02) at any given level, and not just above the normal before upstart of treatment, increased the duration of mucositis. Furthermore elevation of sodium (Na) (p=0.03) at any given level, decrease the time to mucositis. Conclusion: Mucositis and nutritional risk is common in HDT, with high prevalence of the need for Enteral and Parenteral Nutrition. Attention should be given to prevention of mucositis and timing of nutritional therapy, as well as studies looking into the importance of focusing on the levels of K and Na prior to HDT treatment.