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Conrad Notes
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M.E. Hill, MD, Royal Marsden NHS Trust, Sutton, UK, found that nutritional status had little or no effect on 150-day survival following bone marrow transplant (BMT) in acute myeloid leukemia (AML) patients. Ideal body weight (IBW) and body mass index (BMI) served as measures of patient nutrition. Data collected on 232 AML patients also showed nonsignificant effects of nutritional status on time in hospital or platelet recovery time.

Introduction to study Although unproven in benefit, enteral and parenteral feeding are often used after stem cell transplantation in AML patients. Deeg et al reported that fewer underweight patients survived the first 150 days after BMT (Bone Marrow Transplant 1995;15:461-468). Log rank statistics and multivariate Cox regression analyses showed that adult patients with <95% IBW were at increased risk for death soon after transplant (p<0.01). This report prompted Hill and coworkers to undertake a study in 232 AML patients.
Description of study patients Hill et al included >16 year old AML patients in first remission and undergoing autologous or allogeneic BMT:

Parameter Autograft Allograft
No. of  Patients 78 154
Males 50 83
Median Age (y) 37 32
<95% IBW 7 45
>95% IBW 71 109
BMI<20 4 26
BMI=20-25 40 82
BMI>25 34 46
Notes: IBW=Ideal Body Weight corrected for height
BMI=Body Mass Index, weight in kg/ht in msq

BMI served to classify AML patients as underweight (<20), normal (20-25), and overweight (>25).

A dietician routinely assessed all patients. Nasogastric or intravenous supplements were given to very few patients, according to Hill.

Analysis of data Group analyses focused on survival up to Day 150 post-BMT, time in hospital, and recovery times for neutrophils and platelets. Statistical analyses consisted of Kaplan-Meier plots, log rank, and Fischer's exact.

Results on 232 AML patients Nutritional status, measured as % IBW or BMI, did not have a significant influence on 150-day post-BMT survival in autograft or allograft AML patients (Chi square p>0.10). Only patients in the underweight (<95% IBW) allograft group showed a significant delay in neutrophil recovery time (p=0.02). This effect was not seen with low BMI. Neither time to platelet recovery nor time in hospital were effected in either group by BMI or % IBW.

Investigator conclusions According to Hill et al, data from this study fail to support the use of supplemental feeding before or during BMT in AML patients. Nutritional status appears to be unrelated to mortality, time in hospital, or time to platelet recovery during the 150-day post-BMT period. The longer median time to recovery of neutrophils seen in the underweight allograft patients may not be clinically pertinent in the absence of significant changes in survival time or hospital days.

Conrad comments Hill and associates questioned the conventional wisdom of nutritional supplements for AML patients receiving BMT. Allograft patients clearly failed to show a significant association between % IBW or BWI and increased risk during the 150-day observation period. Data are needed for longer follow-up along with additional autograft patients. The UK National Health Service deserves commendation for supporting research which seeks evidence to confirm or disprove time-honored procedures.

For professional correspondence, please contact Dr. Hill by Fax at: 44 181 643 9414 or E-mail at: Markh@icr.ac.uk

Eugene A. Conrad

Presented at The American Society of Hematology (ASH) Meeting, December 5-9, 1997
Copyright © 1998 Conrad Group, Inc. All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078-2230 / February 1998
Send comments to: ConradNote@aol.com

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