Factors Influencing Loss of Body Weight in Cord Blood Transplantation with Nutritional Support for Hematopoietic Stem Cell Transplantation

Background and Objective: Patients may experience nutrition-related adverse events during hematopoietic stem cell transplantation (HSCT) and long-term nutritional intervention was likely needed after cord blood transplantation (CBT) for HSCT due to the long engraftment period. Previous studies have examined nutritional therapy for HSCT but there has been no discussion of loss of body weight (LBW) for CBT patients on HSCT nutritional pathways or of the specific nutritional interventions used. The objective of this study was to identify the specific factors influencing LBW in this patient population and to evaluate the nutritional intervention implemented. Materials and Methods: Subjects in this retrospective exploratory pilot study were 15 patients who underwent CBT with nutritional support following the HSCT nutritional pathway at the Department of Stem Cell Transplantation, Shizuoka Cancer Center, between 2008 and 2012. Correlations were assessed using Pearson’s product-moment correlation coefficients between percent loss of body weight (%LBW) and bioelectrical impedance analysis results, nutrient intake and graft-versus-host disease (GVHD) as well as between continuous oral intake percentage and nutrition-related adverse events (severity score) and orally ingested calories. Spearman rank-order correlation was used to analyze severity scores. Data was also analyzed using JMP. Results: Body weight and skeletal muscle mass decreased significantly during follow-up. Percent LBW was correlated with percent loss of skeletal muscle mass (r = 0.89, p<0.001), total nutrient intake (calories: r = 0.69, p<0.001 and protein: r = 0.69, p = 0.02), orally ingested intake (calories: r = 0.53, p = 0.04 and protein: r = 0.60, p = 0.01) and intestinal acute GVHD (r = 0.63, p = 0.01). Continuous oral intake percentage was correlated with nutrition-related adverse events (severity score: r = 0.66, p<0.001) and orally ingested calories (r = !0.55, p<0.001). Conclusion: Nutritional complications are unavoidable factors influencing LBW in CBT patients on the HSCT nutritional pathway and early nutritional intervention is required. To attenuate LBW in these patients, the intensity of nutritional intervention should be adjusted based on severity scores for nutrition-related adverse events.