Comparação de métodos de avaliação nutricional empregados no acompanhamento de pacientes submetidos a transplante de células-tronco hematopoéticas alogênico / Comparison of nutritional assessment methods employed to monitor patients undergoing allogeneic stem cell transplantation

Pacientes submetidos a transplante de células-tronco hematopoéticas alogênico (TCTH alo) exigem atenção diferenciada devido à agressividade do tratamento. O objetivo desse trabalho foi comparar os métodos disponíveis e a frequência de avaliações nutricionais nesses pacientes. Dezessete pacientes foram avaliados semanalmente entre o dia D-7 e D+28, divididos em cinco intervalos. Foram avaliados altura, peso, índice de massa corporal (IMC), circunferência do braço (CB), dobra cutânea tricipital (DCT), circunferência muscular do braço (CMB), percentual de perda de peso ( por centoPP), dosagem de albumina sérica, balanço hídrico total (BHT), controle de ingestão e percentual de massa magra (MM), massa gorda (MG) e água (H2O) através de bioimpedância elétrica. A média de consumo energético foi de 1.377 (DP±582Kcal). 76,47 por cento (n=13) deles tiveram diminuição de peso e, desses, 57 por cento (n=8) foram classificados como significativo; a média de por centoPP foi de 6,27 Kg (DP±4,25). A CB mostrou diferença significativa (p<0,05) entre cinco intervalos, mostrando-se a mais sensível das medidas antropométricas. Os por cento MM e por cento MG mostraram diferença significativa (p<0,05) entre quatro intervalos. Pela correlação de Pearson mostrou-se significativa (p<0,01) para as variáveis: peso X CB; CB X DCT; CB X CMB; CB X IMC; MM X MG; MM X H2O; BHT X H2O. O percentual de perda de peso se mostrou o mais sensível dos métodos avaliados, e, associado às avaliações de DCT e CB quinzenais, é adequado para o acompanhamento da evolução do estado nutricional.

Patients undergoing hematopoietic stem cell transplantation require special attention due to the aggressiveness of treatment. The aim of this study was to compare methods used to monitor nutritional status (including anthropometric methods of bioelectrical impedance analysis, dietary intake and biochemical control) and the frequency of nutritional evaluations in these patients. Weekly assessments were performed for six female and eleven male patients between day (D)-7 and D+28, divided into 5 time intervals. The height, weight, triceps skinfold (TS), arm circumference (AC), arm muscle circumference (AMC), percentage of weight loss ( percentWL), concentration of serum albumin, body mass index (BMI), total water balance (TWB) and control of intake were evaluated. Additionally, the percentages of lean mass (LM), fat mass (FM) and water (H2O) were assessed by electric bioimpedance. The average daily food intake was 1377 ± 582Kcal. Of the total, 76.47 percent (n = 13) of patients suffered weight loss with 57 percent (n = 8) of weight loss being classified as significant. Among the different anthropometric measurements, arm circumference was the most sensitive with significant differences between the 5 time intervals. Additionally, there were significant differences for the percentages of lean mass (p <0.05) and for fat mass (p <0.05). Using the Pearson correlation, significant differences (p <0.01) were calculated for the following variables: weight vs. AC, AC vs. TS, AC vs. AMC, AC vs. BMI, LM vs. FM, LM vs. H2O and H2O vs. TWB. According to the results, the percentage of weight loss in association with fortnightly DCT and CB assessments are the best way to monitor the nutritional status.

Clinical practice guideline for chronic myelogenous leukemia and its practice in China / 中国实用内科杂志

Imatinib mesylate,as the first generation Bcr-Abl tyrosine kinase inhibitor,has brought revolutionary treatment for Philadelphia chromosome (Ph)-positive chronic myelogenous leukemia (CML);it has been recommended as the first-line treatment for CML by NCCN Practice Guidelines in Oncology in 2008 and European LeukemiaNet(ELN) criteria.However,imatinib has three limitations:first,it is expensive and can not be stopped if efficancy to be maintained;Second,some 20%~30% of patients develope resistance to imatinib;and third,the CML patients can not be cured with imatinib.Taking into consideration of the situation in China,we recommend individual therapy using TKI,HSCT,interferon and cytotoxic drugs for CML patients in China.