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Given the absence of consensus on oral feeding of patients undergoing allogeneic hematopoietic transplantation, the ninth workshops of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) allocated one session to address this topic, especially during the hospitalization. A questionnaire was sent to all SFGM-TC pediatric and adult centers in order to investigate oral feeding practices. The results demonstrated a large disparity among centers regarding oral feeding. Here, we report our recommendations regarding the oral feeding after allogeneic hematopoietic cell transplantation in terms of quality, quantity and bacterial authorized load.

Allogeneic haematopoietic stem-cell transplantation is usually applied with success for patients with diseases involving bone marrow and associated with frequent and severe malnutrition. Denutrition is an independent survival factor and contribute to transplant-related mortality. Due to the heaviness of the treatment, this event is frequent. Before allogeneic transplantation, the nutritional statute should be evaluated. The adult or pediatric patient's evaluation modalities and nutritional needs are detailed in this paper. The administration modalities (enteral or parenteral) with doses are specifically precise. We also explain why the enteral nutritional support may remain the best option comparing to parenteral option.

Resume Dans une demarche qui vise a uniformiser les procedures de greffe de cellules souches hematopoietiques, la Societe francophone de greffe de moelle et de therapie cellulaire (SFGM-TC) a organise les septiemes Ateliers d’harmonisation des pratiques en allogreffe en septembre 2016 a Lille. Le but de ces ateliers annuels est de trouver un terrain d’entente entre des centres qui le souhaitent dans les domaines ou la litterature ne fournit pas de reponses incontestables et consensuelles. Dans cet atelier, nous elaborons le carnet national destine aux patients autogreffes.

Given the absence of consensus on oral feeding of patients undergoing allogeneic hematopoietic transplantation, the ninth workshops of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) allocated one session to address this topic, especially during the hospitalization. A questionnaire was sent to all SFGM-TC pediatric and adult centers in order to investigate oral feeding practices. The results demonstrated a large disparity among centers regarding oral feeding. Here, we report our recommendations regarding the oral feeding after allogeneic hematopoietic cell transplantation in terms of quality, quantity and bacterial authorized load.

Introduction et but de l’etude La valeur pronostique des parametres nutritionnels apres une allogreffe de cellules souches hematopoietiques (allo-CSH) est meconnue. L’objectif etait d’etudier l’impact des parametres nutritionnels sur la survie actuarielle a 2 ans de patients adultes allogreffes et de determiner lesquels de ses facteurs avaient la meilleure valeur pronostique. Materiel et methodes Cette etude retrospective, monocentrique, concernaient les patients allogreffes entre le 1er janvier 2013 et le 30 juin 2016. Avant la greffe, tous les patients recevaient une information concernant le benefice d’initier une nutrition enterale (NE) cyclique nocturne le lendemain de celle-ci. La perte de poids (PdP) exprimee en pourcentage du poids habituel, l’IMC, la circonference brachiale, le force de prehension evaluee par grip test (GT) et l’albuminemie dosee par nephelometrie ont ete recueillies, lorsqu’elles etaient realisees, a J-7 (jour d’admission), J1 et J100 apres l’allo-CSH. Les parametres non nutritionnels lies aux patients, a l’allogreffe et a ses complications dans les 100 premiers jours ont egalement ete collectes. Une analyse de survie univariee (log rank), puis multivariee (modele de Cox) ajustee sur les parametres non-nutritionnels ont ete utilisees pour determiner les facteurs associes a la mortalite a 2 ans. Resultats et analyse statistique Parmi les 276 patients inclus âges de 48,8 ± 15,0 ans , 53 % etaient allogreffes pour leucemie aigue, 17 % pour syndrome myelodysplasique, 12 % pour lymphome et 18 % pour un autre type d’hemopathie. A J1, 92 % d’entre eux ont beneficie d’une NE d’une duree de 18 ± 11 j, en complement de leur alimentation orale. La PdP s’aggravait entre J1 et J100 (3,9 ± 8,2 % et 9,4 ± 10,2 %, p 5 %, l’albuminemie ≤ 35 g/L et le GLIM a J-7; la PdP > 5 %, la CB ≤ 27 cm, l’albuminemie et le GLIM a J1; l’IMC 5 % a J-7 (HR = 1,79, IC 95 % [1,19–2,67], p = 0,005), l’albuminemie ≤ 35 g/L a J1 (HR = 2,10, IC 95 % [1,31–3,36], p = 0,002) et le GT ≤ 25 kg a J100 (HR = 2,86, IC 95 % [1,48–5,50], p = 0,002). Ces facteurs surpassaient les parametres non nutritionnels a chacun des 3 temps d’etudes realises. Conclusion L’utilisation de ces facteurs nutritionnels facilite l’identification des allogreffes a risque de mortalite. Malgre la NE precoce, la denutrition s’aggrave dans les deux mois suivant la sortie et s’accompagne d’une sarcopenie hautement predictive de mortalite. Ses resultats suggerent l’interet, chez les patients amaigris, d’une prise en charge pre-greffe associant soutien nutritionnel et activite physique adaptee.

In an attempt to harmonize clinical practices among French hematopoietic stem cell transplantation centers, the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held its seventh annual workshop series in September 2016 in Lille. This event brought together practitioners from across the country. Our workshop discusses the creation of a patient care logbook for patients undergoing autologous hematopoietic cell transplantation.

Resume Les patients recevant une allogreffe de cellules souches hematopoietiques (ACSH) apres conditionnement myeloablatif (CMA) ont un risque majeur de denutrition. Cette derniere est reconnue pour etre un facteur independant de surmortalite dans cette pathologie. Le cas de cette patiente hospitalisee en 2007 illustre le type de prise en charge developpee par l’unite transversale de nutrition clinique (UTNC) du CHRU de Lille depuis les annees 2000, au decours d’une ACSH-CMA.

Allogeneic haematopoietic stem-cell transplantation is usually applied with success for patients with diseases involving bone marrow and associated with frequent and severe malnutrition. Denutrition is an independent survival factor and contribute to transplant-related mortality. Due to the heaviness of the treatment, this event is frequent. Before allogeneic transplantation, the nutritional statute should be evaluated. The adult or pediatric patient's evaluation modalities and nutritional needs are detailed in this paper. The administration modalities (enteral or parenteral) with doses are specifically precise. We also explain why the enteral nutritional support may remain the best option comparing to parenteral option.

7043 Background: The aim of this work was to investigate the evolution of our practices regarding nutritional support and its impact on early outcomes over the last 5 years. Methods: From Jan 01 to...

Since the early 2003 with the encouraging preliminary results of our pivotal study (Seguy, transplantation), all pts refereed to our unit for myeloablative Allogenic Stem Cell Transplantation (allo-CST) were offered right away enteral feeding via a naso-gastric tube (NGT). The aim of this work was to investigate the evolution of our practices regarding nutritional support and its impact on early outcomes over the last five years. During a systematic individual pre-transplantation interview, all pts were provided with comprehensive information regarding NGT feeding. They received advice on an ongoing basis from a multidisciplinary team. Between Jan 01 and Dec 05, 121 pts who underwent myeloablative allo-SCT were offered EN. Among them, 94 (78%) agreed to receive EN (EN group) and 27 (22%) refused the NGT (without EN group: WEN group) and received either parenteral nutrition (PN) (n=22) or oral feeding only (n=5). The NGT was inserted shortly after transplantation. Bacteriological high-controlled oral diet intake was encouraged for as long as the patient was able to sustain it. The daily oral intake was scheduled to provide 100% of estimated requirements for energy (30–35 kcal/kg/day). Overnight NGT feeding, was gradually increased depending on the patient’s tolerance in order to reach 50–70% of energy requirement within 5 days. In case of intolerance toward EN, additional or total PN was given. In the WEN group, pts received PN when total oral intake was less than two-thirds of the average energy requirement over 5 days. Except for the pts’ age (EN-group, 38y vs WEN 28y, p=.038), the two groups were comparable in terms of initial pts’ characteristics and transplantation modalities. Median duration of EN was 14 days (1–59) and 61 pts received no additional PN while the median duration of the PN was 12 days (2–70). There was no significant difference between the two groups regarding duration of hospitalization, nutritional status at discharge and duration and grade of mucositis. Significant differences were observed, however: engraftment, 100% vs 93%, p=.05, duration of neutropenia, 20d (10–64) vs 25d (18–100), p=.0001 and thrombopenia 27d (6–100) vs 56d (50–100), p=.014; serum albumine level at discharge < 35g/L, 45% vs 76%, p=.005 for EN-group vs WEN-group, respectively. Pts with EN developed less often acute grade III/IV GVHD (9% vs 37%; p=0.001) and non-bacterial infections (9% vs 41%; p=.0002). In addition, pts with enteral feeding had better 100-day survival (92% vs. 67%, P=0.001) with less infection-related deaths. In multivariate analysis the absence of enteral nutrition was the only factor adversely influencing 100-day survival (CI 95%: 1.55–14.9 0.646; P=.007). In order to evaluate the practices over time regarding nutritional support in our unit, we compared the initial period (2001–02) when pts (n=41) had the choice between EN and PN with the second period (2003–05) when EN was offered systematically (n=80). In the second period, pts received less often PN (73% vs. 31%, p CONCLUSION: EN has been well tolerated and dramatically reduced the proportion of pts requiring PN. This study confirms the positive impact of EN on early outcome of pts undergoing myeloablative allo-CST. When possible EN should be preferred to PN.