Acompanhamento e análise do perfil do estado nutricional de pacientes com doença onco-hematológica submetido ao transplante de células-tronco hematopoiéticas

Abstract

Complications related to hematopoietic stem cell transplantation (HSCT) are largely due to toxicity associated with the conditioning regimen and immunological side effects, consequently directly impacting nutritional status. The objective of this study was to describe and evaluate the nutritional status of patients with hematological disease at different times of treatment for hematopoietic stem cell transplantation and its relationship with bone marrow recovery. A prospective longitudinal descriptive study was carried out with patients diagnosed with onco-hematological diseases submitted to HSCT at Bone Marrow Transplant Center of the José Alencar Gomes da Silva National Cancer Institute (CEMO/INCA) in Rio de Janeiro. Only adults aged over 20 years were included. Nutritional status was assessed by the patient generated subjective global assessment (PG-SGA), handgrip strength (HGS) and body mass index (BMI) at the pre-transplantation moments and at the time of discharge from the inpatient unit. For the determination of engraftment, it was considered when the blood counts of neutrophils (granulocytes) were greater than or equal to 500 cells/mm3 for three consecutive days, and when the platelets were above 20,000 cells/mm3, and without the need for blood transfusions for more than seven days. The study was approved by the Research Ethics Committee of INCA (CEP/INCA) on July 4, 2018 (CAAE 89475318.3.0000.5274). The SPSS program, version 17.0 was used for statistical analysis. For all statistical tests, a significance level of 5% was adopted. Sixty-three patients were included in the study, of which 76.2% were submitted to autologous HCT, with the main conditioning and diagnostic regimen, respectively, Melphalan 200mg/m2/d and multiple myeloma. The median time to engraftment was 10 days after the infusion of hematopoietic stem cells, with hospitalization periods for the transplant of 23 days. At admission, most of the sample was classified as well nourished by the PG-SGA and average BMI equivalent to the classification of overweight for adults. There was weight loss, reduction in BMI and reduction in HGS in the period between admission and discharge, as well as a significant increase in the PG-SGA score. There was a positive correlation between grafting time and length of stay, and a negative correlation between BMI at admission and length of stay. A trend was found in the correlation between BMI and HGS of hospitalization with grafting time. Thus, there were no correlations between the variables of nutritional status and grafting, but a negative correlation was found between BMI and length of hospital stay.