Body composition assessment in hematopoietic stem cell transplantation☆

Nutritional status is an important factor influencing outcomes in persons undergoing hematopoietic stem cell transplantation (HSCT). While quantitative measurements such as body mass index (BMI) and weight change and serum markers such as albumin are commonly used in the preand post-transplant evaluations, these parameters in isolation give an incomplete understanding of overall health status. A more comprehensive evaluation of body composition and its relation to functional status preand post-transplant would facilitate the implementation of interventions aimed to improve outcomes in transplant recipients. Prior studies of allogeneic transplant recipients have identified low BMI, low body weight, or weight loss during transplant as measurements of nutritional status correlating with inferior clinical outcomes.1 Low pre-transplant BMI <18.5 kg/m2 has been associated with worse survival, higher treatment-related mortality and in some instances higher risk of disease relapse.2 Other studies indicate that the majority of transplant recipients experience 5–10% decreases in pre-transplant BMI or body weight after transplant,3 likely attributed to acute toxicities of transplant conditioning regimens or complications such as graft-versus-host disease. While such studies are limited by observational or retrospective study design, the available data indicates that malnutrition before and after transplant is associated with adverse outcomes.