Impacto do estado nutricional nos desfechos clínicos de pacientes submetidos a transplante alogênico de células progenitoras hematopoéticas

• Ano de defesa: 2019
• Autor(a) principal: Hirose, Erika Yuri [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Malnutrition; Global subjective evaluation; Graft versus host disease; Allogeneic hematopoietic progenitor cell transplantation; Survival; Desnutrição; Avaliação subjetiva global; Doença do enxerto contra hospedeiro; Transplante de células progenitoras hematopoéticas alogênico; Sobrevida
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7699128; https://repositorio.unifesp.br/handle/11600/59593

Background: Malnutrition is a common finding in allogeneic hematopoietic stem cell transplantation (alloHSCT) patients, and its influence on transplant outcomes is uncertain, with conflicting results. Objetive: This study aims to compare the nutritional status of adult patients submitted to alloHSCT at admission and to evaluate the impact of nutritional status on clinical outcomes. Methods: We performed a retrospective study with 148 patients aged 18 to 75 years with hematological diseases who underwent alloHSCT between 2011 and 2017. Patients were classified according to the body mass index (BMI) and the Subjective Global Assessment (SGA). The SGA classifies patients into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished). Results: At admission, the SGA classified 49 (33%) patients as well-nourished, 54 (37%) as moderately malnourished, and 45 (30%) as severely malnourished. The cumulative incidence (CI) of acute graft-versus-host disease (aGVHD) at 120 days was higher in severely malnourished patients (C-SGA) than in A-SGA or B- group patients, with cumulative incidence rates of 58% vs. 38%, respectively (P=0.016). C-SGA was also associated with severe aGVHD with a CI of 31% vs. a CI of 14% for combined well-nourished or moderately malnourished group (A-SGA or B-, P=0.017). Progression-free survival (PFS) and overall survival (OS) at 3 years were also significantly worse for C-SGA compared to combined A-SGA or B-: PFS rates were 61% vs. 19% (P<0.0001), respectively, and OS rates were 66% vs. 22% (P<0.0001), respectively. Conclusion: Malnutrition is common before alloHSCT, increases the risk of aGVHD and has a negative impact on survival.