Nutritional status of children undergoing hematopoietic stem cell transplantation and its association with post transplantation engraftment / 中华实用儿科临床杂志

ABSTRACT

Objective To assess the nutritional status of children who will receive hematopoietic stem cell transplantation,and to describe the impact of nutritional status on engraftment.Methods From December 2013 to November 2014,54 patients undergoing hematopoietic stem cell transplantation in Hematology and Oncology Center,Beijing Children's Hospital,Capital Medical University were prospectively enrolled into the study,among them 42 patients were undergoing allogeneic hematopoietic stem cell transplantation and 26 patients were suffered from peripheral blood hematopoietic stem cell transplantation.The data about nutrition were collected before preconditioning,at the 0th,30th,60th and 100th day after transplantation,and the levels were considered including weight,height,serum albumin and prealbumin.The time of engraftment was also collected,and the association between engraftment and nutritional states before transplantation was analyzed.Results (1) According to body mass index (BMI) for age,weight for age Z score which normal in ± 2 s to assess the nutritional status of patients before transplantation,the ratio of malnutrition or underweight were 3.7％ (2/54 cases) and 5.6％ (3/54 cases),and the ratio of obesity was 11.1％ (6/54 cases).The incidence of serum albumin and serum prealbumin below normal lower limit was 5.6％ (3/54 cases)and 20.4％ (11/54 cases),respectively before transplantation.And during transplantation,BMI,weight,albumin levels were obviously decreased after conditioning,and those were significantly lower than the baseline (all P ＜ 0.05).(2) The time of granulocyte engraftment and the time of platelet engraftment in patients whose serum albumin level were lower than normal below limit was (17.30 ± 5.13) days and (41.50 ± 19.09) days,while which were (12.70 ± 2.39) days and(20.90 ± 7.25) days in those patients with normal serum albumin level,and the differences were statistically significant (Z =-2.075,-1.969;P =0.031,0.022).(3) Multiple linear regression analysis showed that BMI,serum albumin,prealbumin,mononuclear cell count and CD34 + cell count had impact on engraftment in patients undergoing allogeneic hematopoietic stem cell transplantation (F =2.714,P ＜ 0.05).Conclusions Pediatric patients who will receive hematopoietic stem cell transplantation have malnutrition before transplantation and the risk of malnutrition may increase further during acute period of hematopoietic stem cell transplantation.In addition,patients with low IBM or hypoalbuminemia before transplantation may prolong the time of engraftment,so to improve the nutritional status of patients undergoing hematopoietic stem cell transplantation is in favor of engraftment.