Nutritional Management of Hematopoietic Cell Transplantation

Question 1

What is the difference between auto and and allo HCT?

Answer 1

• Auto: uses patient’s own stem cells
• Allo: uses donor stem cells

Question 2

What are the three categories of conditioning regimens?

Answer 2

• High-dose (myeloablative): combo of chemo agents that ablate bone marrow hematopoiesis and do not allow for autologous reconstitution; require SCT
• Nonmyeloablative: uses chemo that causes minimal cytopenias; does not require SCT
• Reduced intensity conditioning (RIC): uses less intensive chemo or TBI (or both) that causes prolonged cytopenias; require SCT

Question 3

What is the average time until engraftment for each type of stem cell transplant?

Answer 3

• Auto: 10-12 days
• Allo:
  – matched donor w/ peripheral blood: 14-16 days
  – haploidentical: 14-16 days
  – matched donor with bone marrow: 19-21 days
  – umbilical cord blood: 21 days

Question 4

What are the daily energy requirements for children and adults during HCT?

Answer 4

0-6 yrs: BMR x1.6-1.8
7-14 yrs: BMR x1.4-1.6
15-18 yrs: BMR x1.5-1.6
Adults: BMR x1.3-1.5, or 25-30 kcal/kg BW

Question 5

What are the daily protein requirements for children and adults during HCT?

Answer 5

0-12 months: 3 g/kg BW
1-6 yrs: 2.5 g/kg BW
7-10 yrs: 2.4 g/kg BW
11-14 yrs: 2 g/kg BW
15-18 yrs: 1.8 g/kg BW
Adults: 1.5 g/kg BW (or 2-2.5 g/kg IBW if obese)

Question 6

What are the daily fluid requirements for children and adults during HCT?

Answer 6

1-10 kg: 100 mL/kg BW
11-20 kg: 1,000 mL + 50 mL/kg for every kg over 10 kg BW
>20 kg: 1,500 mL + 20 mL/kg for every kg over 20 kg BW

Question 7

True or False: GVHD is a T-cell mediated immunologic reaction of engrafted lymphoid cells against the host tissues.

Answer 7

True

Question 8

What 3 organs are most often affected by GVHD?

Answer 8

Skin (75%), GI tract (50%), Liver (20%)

Question 9

True or False: GVHD cannot occur after autologous HCT.

Answer 9

False, it can occur but is less common and usually less severe

Question 10

True or False: Pediatric HCT survivors are more likely to develop diabetes and HTN than the general population.

Answer 10

True

Question 11

What are some nutrition-related oral, GI, and pulmonary outcomes of chronic GVHD?

Answer 11

Oral: xerostomia, dysphagia -> reduced food variety and decreased intake
GI: intestinal mucosa changes, bile salt deficiency, pancreatic enzyme insufficiency, bacterial overgrowth -> diarrhea, malabsorption
Pulmonary: pulmonary insufficiency -> increase energy requirements

Question 12

True or False: Iron supplementation is recommended during HCT.

Answer 12

False; iron overload is often observed d/t receiving multiple RBC transfusions, so supplementation is contraindicated