Role of prophylactic enteral nutrition in meeting nutritional needs during autologous hematopoietic stem cells transplants.

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Background and objectives Intensive therapy with autologous hematopoietic stem cell transplantation (HSCT) for lymphomas and myelomas significantly increases the risk of malnutrition. Artificial nutrition is crucial to meet nutritional needs. Although learned societies recommend enteral nutrition (EN) via nasogastric tube when the digestive tract is functional, it often fails, requiring parenteral nutrition (PN) in these patients with deep aplasia. This prospective cohort study evaluated the role of prophylactic EN in meeting the needs of 200 patients receiving autologous HSCT, according to BEAM and Melphalan conditioning regimens. Material & Methods Our study is a prospective cohort study. EN was considered sufficient when, associated with food intake, it covered at least 70% of nutritional needs without requiring to PN. In case of EN failure, a primary failure was defined when EN was not started whereas a secondary failure was defined when EN was started but discontinued. Statistical analyses used descriptive statistics, chi-square tests, and Mann-Whitney U tests. Results Overall, 200 patients were included: 120 were treated with Melphalan for myeloma and 80 with BEAM for lymphoma. EN was sufficient without requiring PN in 25.89 % of patients (95% CI: 19.92; 32.59), higher in Melphalan-conditioned patients: 32.20% (95% CI: 23.90; 41.43), compared to BEAM-conditioned patients 16.45% (95% CI: 9.06; 26.49). Primary failures accounted for 21.5% of cases, mainly due to difficulties in inserting the nasogastric tube (13%), vomiting of the tube (3%), or patient requests for removal (4.5%). Secondary failures accounted for 38% of cases, primarily due to patient requests for removal (15.5%), vomiting of the tube without reinsertion (12.5%), and upper digestive intolerance (4%). The median percentage of weight loss was 3.8% (IQR: 1.6- 6.3%) , with a significant higher loss in the BEAM group (5.2%, IQR: 2.0–7.0%) compared to the Melphalan group (3.3%, IQR: 1.5–5.1%). The prevalence of malnutrition increased from 20% at admission to 48% at discharge, with severe malnutrition rising from 5.1% to 30%. This study highlights the limits of prophylactic EN in autologous HSCT, particularly in BEAM-conditioned patients. Combined strategies (EN + PN) should be considered to optimize nutritional support in this high-risk population.

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