Chapter 16: MNT for Hematopoietic Cell Transplantation Flashcards
Conditions that are treated with HCT?
acute leukemia, chronic leukemia, lymphoma, Hodgkin’s disease, Myelodysplastic syndrome, multiple myeloma and solid tumors (advanced stage neuroblastoma, refractory Ewing’s sarcoma)
What is the object of HCT?
to replace the malignant of defective marrow in order to restore normal hematopoiesis and immunologic function. Treatment includes chemotherapy and may include total body irradiation (TBI)
What are the two types of HCT preparative conditioning regimens?
Myeloblastive and nonmyeloblastive
Myeloblastive regimen includes…
both high dose chemotherapy and radiation to eliminate disease and ablate bone marrow
nonmyeloblastive regimen includes…
delivers low dose chemotherapy and radiation
Autologous infusion
the patient’s own stem cells
Syngeneic infusion
cells from the patient’s identical twin
Allogenic infusion
cells from unrelated donor (or human leukocyte antigen related)
What is neutropenic?
decreased number of neutrophils in the blood and immunosuppressed for a period of 2-3 weeks until engraftment
With HCT, how often should a nutrition evaluation be done?
Pre-transplant and repeated periodically throughout the transplant course
Nutrition history should include…
Oral and GI symptoms: xerostomia, chewing or swallowing difficulties, mucositis or esophagitis, taste alterations, heart burn, nausea, vomiting, early satiety, anorexia and altered bowel habits. Also, current diet, supplements, food allergies,
Anthropometric measurements should include…
height, weight, weight history, arm anthropometry
Biochemical indices should include…
electrolytes, glucose, renal, liver function enzymes, visceral proteins, blood lipids, ferritin, 25-OH vitaminD
How frequently should nutrition support be monitored during HCT?
daily
How long should autologous transplant patients follow an immunosuppression diet?
For the first 3 months after transplant.
How long should allogenic transplant patients follow an immunosuppression diet?
Until immunosuppressive therapy is discontinued
Diet guidelines for immunosuppressed patients?
No: raw/undercooked meat, eggs, chicken, etc, raw tofu, lunchmeats (unless cooked until steaming), smoked seafood (lox), unpasteurized/raw milk, cheese, yogurt, blue-veined cheese, uncooked soft cheese, mexican-style cheese, foods containing raw eggs, unwashed fruits/vegetables, raw vegetable sprouts, unpasteurized juices, raw/unpasteurized honey, well water must be boiled for 15-20 min
What is Sinusoidal Obstructive Syndrome (SOS)?
It is characterized by toxic injury to the sinusoidal and venular epithelium.
What are symptoms of Sinusoidal Obstructive Syndrome (SOS)?
insidious weight gain, ascites, right upper quadrant tenderness and painful hepatomegaly, hyperbilirubinemia and renal dysfunction.
MNT during Sinusoidal Obstructive Syndrome (SOS)?
concentration of PN fluids as well as medication volumes and reduction of both oral and intravenous sodium to minimize fluid retention. If bilirubin increase to >10, monitor TG.
What is CRRT?
Continuous Renal Replacement Therapy.
What is Graft-Versus-Host-Disease (GVHD)?
A T-cell mediated immunologic reaction of engrafted lymphoid cells against the host tissue. Often effects skin, liver, and GI.
Clinical manifestations of GVHD?
nausea, vomiting, anorexia, diarrhea, abdominal pain, voluminous, secretory diarrhea and intestinal bleeding occur in advanced disease. Intestinal protein losses and fat malabsorption occur d/t mucosal degeneration.
What is the major source of morbidity / mortality in HCT patients?
Infection
