Chapter 16: MNT for Hematopoietic Cell Transplantation

Question 1

Conditions that are treated with HCT?

Answer 1

acute leukemia, chronic leukemia, lymphoma, Hodgkin’s disease, Myelodysplastic syndrome, multiple myeloma and solid tumors (advanced stage neuroblastoma, refractory Ewing’s sarcoma)

Question 2

What is the object of HCT?

Answer 2

to replace the malignant of defective marrow in order to restore normal hematopoiesis and immunologic function. Treatment includes chemotherapy and may include total body irradiation (TBI)

Question 3

What are the two types of HCT preparative conditioning regimens?

Answer 3

Myeloblastive and nonmyeloblastive

Question 4

Myeloblastive regimen includes…

Answer 4

both high dose chemotherapy and radiation to eliminate disease and ablate bone marrow

Question 5

nonmyeloblastive regimen includes…

Answer 5

delivers low dose chemotherapy and radiation

Question 6

Autologous infusion

Answer 6

the patient’s own stem cells

Question 7

Syngeneic infusion

Answer 7

cells from the patient’s identical twin

Question 8

Allogenic infusion

Answer 8

cells from unrelated donor (or human leukocyte antigen related)

Question 9

What is neutropenic?

Answer 9

decreased number of neutrophils in the blood and immunosuppressed for a period of 2-3 weeks until engraftment

Question 10

With HCT, how often should a nutrition evaluation be done?

Answer 10

Pre-transplant and repeated periodically throughout the transplant course

Question 11

Nutrition history should include…

Answer 11

Oral and GI symptoms: xerostomia, chewing or swallowing difficulties, mucositis or esophagitis, taste alterations, heart burn, nausea, vomiting, early satiety, anorexia and altered bowel habits. Also, current diet, supplements, food allergies,

Question 12

Anthropometric measurements should include…

Answer 12

height, weight, weight history, arm anthropometry

Question 13

Biochemical indices should include…

Answer 13

electrolytes, glucose, renal, liver function enzymes, visceral proteins, blood lipids, ferritin, 25-OH vitaminD

Question 14

How frequently should nutrition support be monitored during HCT?

Answer 14

daily

Question 15

How long should autologous transplant patients follow an immunosuppression diet?

Answer 15

For the first 3 months after transplant.

Question 16

How long should allogenic transplant patients follow an immunosuppression diet?

Answer 16

Until immunosuppressive therapy is discontinued

Question 17

Diet guidelines for immunosuppressed patients?

Answer 17

No: raw/undercooked meat, eggs, chicken, etc, raw tofu, lunchmeats (unless cooked until steaming), smoked seafood (lox), unpasteurized/raw milk, cheese, yogurt, blue-veined cheese, uncooked soft cheese, mexican-style cheese, foods containing raw eggs, unwashed fruits/vegetables, raw vegetable sprouts, unpasteurized juices, raw/unpasteurized honey, well water must be boiled for 15-20 min

Question 18

What is Sinusoidal Obstructive Syndrome (SOS)?

Answer 18

It is characterized by toxic injury to the sinusoidal and venular epithelium.

Question 19

What are symptoms of Sinusoidal Obstructive Syndrome (SOS)?

Answer 19

insidious weight gain, ascites, right upper quadrant tenderness and painful hepatomegaly, hyperbilirubinemia and renal dysfunction.

Question 20

MNT during Sinusoidal Obstructive Syndrome (SOS)?

Answer 20

concentration of PN fluids as well as medication volumes and reduction of both oral and intravenous sodium to minimize fluid retention. If bilirubin increase to >10, monitor TG.

Question 21

What is CRRT?

Answer 21

Continuous Renal Replacement Therapy.

Question 22

What is Graft-Versus-Host-Disease (GVHD)?

Answer 22

A T-cell mediated immunologic reaction of engrafted lymphoid cells against the host tissue. Often effects skin, liver, and GI.

Question 23

Clinical manifestations of GVHD?

Answer 23

nausea, vomiting, anorexia, diarrhea, abdominal pain, voluminous, secretory diarrhea and intestinal bleeding occur in advanced disease. Intestinal protein losses and fat malabsorption occur d/t mucosal degeneration.

Question 24

What is the major source of morbidity / mortality in HCT patients?

Answer 24

Infection

Question 25

Nutritional implications associated with chronic GVHD?

Answer 25

Weight gain (d/t corticosteroids), weight loss oral sensitivity to spicy or acidic foods, xerostoma, stomatitis, anorexia, reflux symptoms and diarrhea.

Question 26

GVHD Diet advancement?

Answer 26

1. Bowel rest. 2. Introduction of oral feeding (isotonic, low residue, low-lactose) 3. Introduction of solids (low lactose, low fiber, low acidity, no gastric irritants) 4. Expansion of diet (low lactose, low fiber, low acidity, low fat) 5. Resume regular diet

Question 27

Long-term possible consequences of endocrine damage in HCT patients?

Answer 27

metabolic syndrome (hyperlipidemia, insulin resistance, DM2, obesity, HTN)

Question 28

T/F: Iron overload is a frequent long-term problem after HCT?

Answer 28

True: Iron supplementation and Mvi containing iron should be avoided during and after HCT.

Question 29

Other late side effects of HCT?

Answer 29

secondary malignancies, ocular complications, avascular necrosis, chronic pulmonary effects, thyriod dysfunction, gonadal hormone insufficiency

Question 30

How long should autologous transplant patients follow a neutropenic diet?

Answer 30

For the first 3 months after HCT

Question 31

How long should allogenic transplant patients follow a neutropenic diet?

Answer 31

Until immunosuppressive therapy is discontinued.

Question 32

Adult calorie needs during HCT?

Answer 32

Basal needs x 1.3-1.5

Question 33

Adult protein needs during HCT?

Answer 33

1.5 g/kg

Question 34

Carbohydrate needs during HCT.

Answer 34

50-60% of total energy.

Question 35

Fat needs during HCT?

Answer 35

Minimum: 6-8% total calories
Maximum: 40% total calories.

Question 36

Fluid needs for HCT?

Answer 36

1500 mL/m2 body surface area

Question 37

Oral vitamin guidelines for HCT?

Answer 37

Oral multivitamin without iron.

Question 38

What is SOS?

Answer 38

Injury to the sinusoidal and venular ephithelium.

Question 39

Symptoms of SOS?

Answer 39

Insidious weight gain, ascites, right upper quadrant tenderness and painful hepatomegaly, hyperbilirubinemia and renal dysfunction.