Nutritional Support in Juvenile Cancer Patients under Hematopoietic Stem Cell Transplantation

Abstract

Introduction: Nutritional status is influenced by hematopoietic stem cell transplantation (HTSC). nutritional disorders in HSCT patients are common and are a consequence of the primary disease, cytoreduction therapy performed during the conditioning regimen and complications such as infections, neutropenic enterocolitis, graft versus host disease, among others. Objective: To carry out a narrative review based on the main studies and positioning of experts in literature, in addition to the experience of our group. Method: Bibliographical survey of the main studies and consensus on the nutritional therapy, oncology patient, pediatric oncology patient and transplantation HSCT. Results: Poor nutritional status and nutritional supply can negatively influence immune function during metabolic stress, increasing the risk of complications and disfavoring the prognosis. Nutritional intervention proposals and the main recommendations for oral, enteral and parenteral nutrition therapy were reviewed. Two algorithms were developed, based on the results of the review, discriminating the phases of HSCT, in order to facilitate the decision of nutritional therapy. Conclusion: There is little evidence to support nutritional recommendations  and nutritional therapy for children and adolescents submitted to HSCT. Much information is based on studies with adults or pediatric population oncology in common antineoplastic treatment. There is a need for controlled clinical trials to evaluate the applicability and benefits of nutritional therapy in pediatric patients undergoing HSCT.