Pre-HSCT nutritional support and its impact on post-HSCT nutritional outcome

Abstract

Background: Malnutrition is a common condition in cancer patients, especially those with hemato–oncological diseases, and is a direct consequence of both the disease itself and its treatment. In patients undergoing hematopoietic stem cell transplantation (HSCT), the type of conditioning regimen, the nature of the transplant (autologous vs. allogeneic), and post–transplant complications can significantly affect nutritional status. Conditioning regimens often cause side effects such as mucositis, nausea, vomiting, diarrhea, fever, and infections, which impair food intake, contribute to weight loss, and increase the risk of sarcopenia, affecting 20–70% of patients depending on the type of tumor. Malnutrition is responsible for approximately 10–20% of cancer–related deaths. Therefore, integrating routine malnutrition assessment into clinical care is essential for improving patient outcomes. Methods: A retrospective analysis was conducted using medical records of 120 patients treated at the Hospital of LUHS KC between January 2022 and August 2024. The inclusion criteria were patients who underwent either autologous or allogeneic hematopoietic stem cell transplantation (HSCT). Malnutrition was identified according to the ESPEN guidelines on nutrition in cancer patients, and patients were considered malnourished if parenteral feeding was indicated based on these guidelines. Statistical significance was considered at p < 0.05. Results: Out of 120 patients, 91 (75.8%) underwent autologous HSCT and 29 (24.2%) allogeneic HSCT. Patients receiving allogeneic HSCT had significantly higher rates of malnutrition (55.9%, p < 0.001). The most used conditioning regimen for autologous HSCT was melphalan (76.9%), while reduced–intensity conditioning (RIC) protocols were most common for allogeneic HSCT (37.9%). No significant association was found between conditioning regimens and malnutrition. However, there were significant changes in albumin, protein, and hemoglobin (Hgb) levels before and after HSCT (p < 0.001). Univariate regression analysis showed that higher protein levels before autologous HSCT (OR 0.845, 95%CI 0.743–0.961, p = 0.010) and higher albumin levels after autologous HSCT (OR 0.819, 95%CI 0.685–0.978, p = 0.027) were associated with a reduced risk of malnutrition. Similarly, higher Hgb levels before allogeneic HSCT (OR 0.910, 95%CI 0.834–0.992, p = 0.032) and higher protein levels after allogeneic HSCT (OR 0.724, 95%CI 0.546–0.960, p = 0.025) were also linked to a reduced risk of malnutrition. Conclusions: Patients undergoing allogeneic HSCT were more likely to experience malnutrition. Pre–HSCT nutritional support was found to have a significant impact on nutritional outcomes post–transplant. Additionally, monitoring and timely correction of laboratory parameters such as albumin, protein, and hemoglobin levels can help mitigate the risk of malnutrition.