Keyword: Hematopoietic Stem Cell Transplantation
3 results found.
Congress Abstract
Oncology, Nuclear Medicine and Transplantology, 2(3, Suppl. 1), 2026, onmt_A29, https://doi.org/10.63946/onmt/19333
ABSTRACT:
Introduction: Nutritional deficiency is a significant clinical problem in patients who have undergone hematopoietic stem cell transplantation (HSCT). The development of mucositis, systemic inflammatory response, and infectious complications is accompanied by reduced oral intake, increased catabolic processes, and body weight loss. At the same time, specialized nutritional support in real-world clinical practice is often initiated only after severe complications have already developed, which determines the need to shift from a reactive to an early differentiated strategy of nutritional support.
Objective: To compare nutritional status and clinical complications after autologous and allogeneic HSCT, to assess the associations of severe mucositis, sepsis, and specialized nutritional support with laboratory parameters and length of hospitalization, and to substantiate the need for an algorithm of early differentiated nutritional support.
Materials and Methods: A single-center retrospective study was conducted on 70 patients who underwent HSCT: 35 after autologous and 35 after allogeneic transplantation. Body weight dynamics, total protein and albumin levels, maximum C-reactive protein levels, presence and grade of mucositis, frequency of sepsis and thromboses, microbiological profile of infectious complications, use of specialized nutritional support, and length of hospitalization were analyzed. Comparative analysis was performed taking into account the type of HSCT, presence of severe mucositis, sepsis, and use of nutritional support. Fisher's exact test was used for comparison of categorical variables. Differences were considered statistically significant at p < 0.05.
Results: A body weight loss of more than 5% was statistically significantly more frequent after allogeneic HSCT compared to autologous: 100% vs. 77.1%, respectively (p = 0.005). Sepsis was recorded in 62.9% of patients after allogeneic and 45.7% after autologous HSCT; the difference did not reach statistical significance (p = 0.229). Among cases with identified pathogens, gram-positive microorganisms accounted for 51.4% (n = 19) and gram-negative for 48.6% (n = 18). Resistant or clinically problematic microorganisms were identified in 22 cases of sepsis (57.9%); Klebsiella pneumoniaeand Escherichia coli predominated among the pathogens.
In patients with sepsis, minimum albumin values were lower compared to patients without sepsis: 30.1 vs. 32.5 g/L (p = 0.001), as were minimum total protein values: 50.9 vs. 54.1 g/L (p = 0.033). Maximum C-reactive protein levels were substantially higher: 163.5 vs. 78.0 mg/L (p < 0.001). Sepsis was also associated with a longer length of hospitalization: 36.9 vs. 34.5 days (p = 0.010).
Thrombotic complications were more frequently recorded after allogeneic HSCT: 34.3% vs. 11.4% after autologous HSCT (p = 0.044). With grade III–IV mucositis, specialized nutritional support was received by 39 of 41 patients (95.1%), whereas among patients without severe mucositis – 4 of 29 (13.8%; p < 0.001). Initiation of specialized nutritional support within the first 48 hours was noted in only 4 of 70 patients (5.7%).
After autologous HSCT, the length of hospitalization in patients receiving specialized nutritional support was 36.0 ± 5.7 days vs. 32.2 ± 2.9 days in patients without it (p = 0.03). After allogeneic HSCT, the corresponding values were 37.8 ± 3.2 and 36.3 ± 2.7 days (p > 0.05).
Conclusions: Nutritional disorders are a frequent complication of both autologous and allogeneic HSCT; however, the most pronounced body weight loss is observed after allogeneic transplantation. Sepsis is associated with a more pronounced decrease in albumin and total protein levels, an increase in C-reactive protein, and a longer length of hospitalization. Specialized nutritional support was prescribed predominantly to patients with already developed severe mucositis, whereas its early initiation within the first 48 hours was used only in isolated cases. The obtained data indicate the predominantly reactive nature of the existing nutritional support strategy and substantiate the need for its earlier individualization.
Based on the study results, an algorithm of early differentiated nutritional support for patients after HSCT was developed. Currently, a prospective phase of the study is being conducted with daily monitoring of actual energy and protein intake, volume of nutritional support, and clinical and laboratory dynamics in patients after allogeneic HSCT. The prospective observation is aimed at evaluating the applicability of the developed approach and its subsequent association with nutritional and clinical outcomes.
Objective: To compare nutritional status and clinical complications after autologous and allogeneic HSCT, to assess the associations of severe mucositis, sepsis, and specialized nutritional support with laboratory parameters and length of hospitalization, and to substantiate the need for an algorithm of early differentiated nutritional support.
Materials and Methods: A single-center retrospective study was conducted on 70 patients who underwent HSCT: 35 after autologous and 35 after allogeneic transplantation. Body weight dynamics, total protein and albumin levels, maximum C-reactive protein levels, presence and grade of mucositis, frequency of sepsis and thromboses, microbiological profile of infectious complications, use of specialized nutritional support, and length of hospitalization were analyzed. Comparative analysis was performed taking into account the type of HSCT, presence of severe mucositis, sepsis, and use of nutritional support. Fisher's exact test was used for comparison of categorical variables. Differences were considered statistically significant at p < 0.05.
Results: A body weight loss of more than 5% was statistically significantly more frequent after allogeneic HSCT compared to autologous: 100% vs. 77.1%, respectively (p = 0.005). Sepsis was recorded in 62.9% of patients after allogeneic and 45.7% after autologous HSCT; the difference did not reach statistical significance (p = 0.229). Among cases with identified pathogens, gram-positive microorganisms accounted for 51.4% (n = 19) and gram-negative for 48.6% (n = 18). Resistant or clinically problematic microorganisms were identified in 22 cases of sepsis (57.9%); Klebsiella pneumoniaeand Escherichia coli predominated among the pathogens.
In patients with sepsis, minimum albumin values were lower compared to patients without sepsis: 30.1 vs. 32.5 g/L (p = 0.001), as were minimum total protein values: 50.9 vs. 54.1 g/L (p = 0.033). Maximum C-reactive protein levels were substantially higher: 163.5 vs. 78.0 mg/L (p < 0.001). Sepsis was also associated with a longer length of hospitalization: 36.9 vs. 34.5 days (p = 0.010).
Thrombotic complications were more frequently recorded after allogeneic HSCT: 34.3% vs. 11.4% after autologous HSCT (p = 0.044). With grade III–IV mucositis, specialized nutritional support was received by 39 of 41 patients (95.1%), whereas among patients without severe mucositis – 4 of 29 (13.8%; p < 0.001). Initiation of specialized nutritional support within the first 48 hours was noted in only 4 of 70 patients (5.7%).
After autologous HSCT, the length of hospitalization in patients receiving specialized nutritional support was 36.0 ± 5.7 days vs. 32.2 ± 2.9 days in patients without it (p = 0.03). After allogeneic HSCT, the corresponding values were 37.8 ± 3.2 and 36.3 ± 2.7 days (p > 0.05).
Conclusions: Nutritional disorders are a frequent complication of both autologous and allogeneic HSCT; however, the most pronounced body weight loss is observed after allogeneic transplantation. Sepsis is associated with a more pronounced decrease in albumin and total protein levels, an increase in C-reactive protein, and a longer length of hospitalization. Specialized nutritional support was prescribed predominantly to patients with already developed severe mucositis, whereas its early initiation within the first 48 hours was used only in isolated cases. The obtained data indicate the predominantly reactive nature of the existing nutritional support strategy and substantiate the need for its earlier individualization.
Based on the study results, an algorithm of early differentiated nutritional support for patients after HSCT was developed. Currently, a prospective phase of the study is being conducted with daily monitoring of actual energy and protein intake, volume of nutritional support, and clinical and laboratory dynamics in patients after allogeneic HSCT. The prospective observation is aimed at evaluating the applicability of the developed approach and its subsequent association with nutritional and clinical outcomes.
Congress Abstract
Oncology, Nuclear Medicine and Transplantology, 2(3, Suppl. 1), 2026, onmt_A23, https://doi.org/10.63946/onmt/19329
ABSTRACT:
Introduction: Viral reactivations frequently complicate the post-transplant period; however, unified viral load thresholds and criteria for preemptive therapy of Epstein–Barr virus infection are lacking. Objective: To evaluate the frequency of reactivations and the characteristics of Epstein–Barr virus DNA detection in various biological materials in adults after first allogeneic hematopoietic stem cell transplantation.
Materials and Methods: This single-center retrospective cohort study of anonymized data included 120 patients over 18 years of age after first allogeneic hematopoietic stem cell transplantation in 2023. Six patients with viral events preceding transplantation were excluded; 114 patients were analyzed. Viral DNA was detected by polymerase chain reaction. Reactivation was recorded when more than 500 copies of viral DNA were detected. Quantitative data are presented as median and range, categorical data as number of observations and proportions.
Results: Viral reactivations were recorded in 75 patients (65.8%), with two or more viruses in 33 patients (28.9%). Cytomegalovirus was detected in 41 patients, human herpesvirus type 6 in 30, parvovirus B19 in 27, and Epstein–Barr virus in ten (8.8%). After transplantation, Epstein–Barr virus DNA was detected in blood or bone marrow in ten patients, in gastrointestinal mucosal biopsy specimens in seven, and in bronchoalveolar lavage fluid in ten. When considering all materials, the virus was detected in 23 patients (20.2%); in 13 patients, it was detected only in biopsy specimens or bronchoalveolar lavage fluid. Post-transplant lymphoproliferative disease was not recorded.
Conclusions: Viral reactivations were detected in two-thirds of patients, with multiple viruses in nearly one-third. The detection rate of Epstein–Barr virus DNA depended on the material tested: 8.8% in blood or bone marrow and 20.2% when considering all samples. Local positive results require clinical interpretation. Post-transplant lymphoproliferative disease was not recorded.
Materials and Methods: This single-center retrospective cohort study of anonymized data included 120 patients over 18 years of age after first allogeneic hematopoietic stem cell transplantation in 2023. Six patients with viral events preceding transplantation were excluded; 114 patients were analyzed. Viral DNA was detected by polymerase chain reaction. Reactivation was recorded when more than 500 copies of viral DNA were detected. Quantitative data are presented as median and range, categorical data as number of observations and proportions.
Results: Viral reactivations were recorded in 75 patients (65.8%), with two or more viruses in 33 patients (28.9%). Cytomegalovirus was detected in 41 patients, human herpesvirus type 6 in 30, parvovirus B19 in 27, and Epstein–Barr virus in ten (8.8%). After transplantation, Epstein–Barr virus DNA was detected in blood or bone marrow in ten patients, in gastrointestinal mucosal biopsy specimens in seven, and in bronchoalveolar lavage fluid in ten. When considering all materials, the virus was detected in 23 patients (20.2%); in 13 patients, it was detected only in biopsy specimens or bronchoalveolar lavage fluid. Post-transplant lymphoproliferative disease was not recorded.
Conclusions: Viral reactivations were detected in two-thirds of patients, with multiple viruses in nearly one-third. The detection rate of Epstein–Barr virus DNA depended on the material tested: 8.8% in blood or bone marrow and 20.2% when considering all samples. Local positive results require clinical interpretation. Post-transplant lymphoproliferative disease was not recorded.
Congress Abstract
Oncology, Nuclear Medicine and Transplantology, 2(3, Suppl. 1), 2026, onmt_A10, https://doi.org/10.63946/onmt/19327
ABSTRACT:
Introduction: Catheter-associated thrombosis can lead to dysfunction and unplanned removal of the central venous catheter, as well as to re-catheterization. After hematopoietic stem cell transplantation, its development may be determined by the combined action of the components of Virchow's triad: endothelial injury, venous blood flow disturbance, and hypercoagulability. Objective: To assess the incidence of catheter-associated thrombosis and to interpret the associated clinical factors from the perspective of Virchow's triad in patients after hematopoietic stem cell transplantation.
Materials and Methods: A retrospective single-center study was conducted on 91 episodes of central venous catheter placement in 78 patients at the Department of Bone Transplantation. Risk factors were analyzed in 58 completed primary episodes. Transplant type, conditioning regimen, infectious and mechanical complications, number of puncture attempts, parenteral nutrition, and anticoagulant use were assessed. Fisher's exact test was used; differences were considered statistically significant at p < 0.05.
Results: Catheter-associated thrombosis occurred in both episodes with catheter-associated bloodstream infection (2 of 2, 100%), compared with 9 of 56 episodes without such infection (16.1%; p = 0.033). Thrombosis occurred in 2 of 5 episodes with early mechanical complications (40.0%) and in 9 of 53 episodes without such complications (17.0%; p = 0.237). With prophylactic enoxaparin use, no thrombosis was observed in 12 episodes; without prophylaxis, thrombosis occurred in 11 of 46 episodes (23.9%; p = 0.097). In the Virchow's triad model, infection and mechanical complications corresponded to endothelial injury and local inflammation; the presence of the catheter created conditions for blood flow disturbance; differences by transplant type and enoxaparin use may reflect the contribution of hypercoagulability.
Conclusions: Catheter-associated thrombosis after hematopoietic stem cell transplantation can be viewed as a result of the interaction of all components of Virchow's triad. The association with catheter-associated bloodstream infection supports the role of endothelial injury and local inflammation; the central venous catheter creates conditions for blood flow disturbance; the observed differences by transplant type may reflect differing degrees of systemic prothrombotic factors. Virchow's triad unifies the identified factors into a single mechanism of thrombosis; however, the contribution of individual components requires clarification in a larger sample.
Materials and Methods: A retrospective single-center study was conducted on 91 episodes of central venous catheter placement in 78 patients at the Department of Bone Transplantation. Risk factors were analyzed in 58 completed primary episodes. Transplant type, conditioning regimen, infectious and mechanical complications, number of puncture attempts, parenteral nutrition, and anticoagulant use were assessed. Fisher's exact test was used; differences were considered statistically significant at p < 0.05.
Results: Catheter-associated thrombosis occurred in both episodes with catheter-associated bloodstream infection (2 of 2, 100%), compared with 9 of 56 episodes without such infection (16.1%; p = 0.033). Thrombosis occurred in 2 of 5 episodes with early mechanical complications (40.0%) and in 9 of 53 episodes without such complications (17.0%; p = 0.237). With prophylactic enoxaparin use, no thrombosis was observed in 12 episodes; without prophylaxis, thrombosis occurred in 11 of 46 episodes (23.9%; p = 0.097). In the Virchow's triad model, infection and mechanical complications corresponded to endothelial injury and local inflammation; the presence of the catheter created conditions for blood flow disturbance; differences by transplant type and enoxaparin use may reflect the contribution of hypercoagulability.
Conclusions: Catheter-associated thrombosis after hematopoietic stem cell transplantation can be viewed as a result of the interaction of all components of Virchow's triad. The association with catheter-associated bloodstream infection supports the role of endothelial injury and local inflammation; the central venous catheter creates conditions for blood flow disturbance; the observed differences by transplant type may reflect differing degrees of systemic prothrombotic factors. Virchow's triad unifies the identified factors into a single mechanism of thrombosis; however, the contribution of individual components requires clarification in a larger sample.