Nutrition Support of Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)

Patients with cancer are at risk of malnutrition due to a number of factors, including decreased energy intake, increased energy needs, and/or poor assimilation of dietary intake. The nutritional status of patients undergoing HSCT, however, has not been widely studied. After two influential studies showed better medical outcomes among children with the use of parenteral nutrition (PN) immediately following transplantation, PN became an accepted part of supportive care during HSCT. PN is generally provided to these patients in the amount of 120-140% of estimated basal energy needs, for as long as oral intake is unable to meet dietary energy needs. This process may take 2-4 weeks or longer after transplantation. In order to more fully evaluate the energy needs of pediatric patients undergoing HSCT, we recently performed indirect calorimetry in a cohort of 25 HSCT patients at baseline, and then weekly during the month following transplantation. Detailed dietary intake and laboratory measures of nutritional status were also obtained. We found significant declines in resting energy expenditure (REE) after transplantation. We review the results of our study in light of other studies of energy expenditure in the setting of HSCT. Should our results be replicated, it seems likely that current recommendations for providing nutritional support in HSCT patients may lead to significant overfeeding.