Hematopoietik Kök Hücre Nakli Yapılan Hastalarda Beslenme Durumunun Değerlendirilmesi ve Beslenmenin Nakil ile İlişkili Parametrelere Etkisinin İncelenmesi

Abstract

In this study, the effects of high dose chemotherapy and stem cell transplantation on the patient’s energy and nutrient intake, anthropometric measurements and nitrogen balance in patients undergoing hematopoietic stem cell transplantation were investigated. Patients who applied to Gülhane Military Medical Academy Medical Oncology Clinic and Hematology Clinic between the dates of March 2014 and April 2016 and who fulfilled the criteria of appropriate hematopoietic stem cell transplantation were taken to study. There are 44 patients in the study. Patients were followed up and evaluated before high dose chemotherapy, reinfusion, engraftment and after treatment. Food consumption records, physical activity records on an hourly basis, anthropometric measurement and nitrogen balance measurement were taken from the patients. All patients and subgroups (solid/hematological, allogeneic stem cell transplantation/autologous stem cell transplantation, chemotherapy/chemotherapy+TBI) analyzes were performed in the evaluation of the data. High energy and protein diet was planned and patient’s daily food consumption was monitored. Nutritional support treatments for patients with reduced food intake had started. Especially the patients’ nausea symptoms increased during the reinfusion period and mucositis symptoms increased during the engraftment period. The rate of patients receiving nutritional support treatment during the engraftment period had increased. Patients' energy, protein and many nutrient intakes decreased significantly during reinfusion and especially during engraftment period according to before chemotherapy period. In the post-treatment period, the energy and protein intake of the patients increased but also significantly lower than before the chemotherapy period (p <0,05). In the subgroups, energy, protein and other nutrient intake of patients receiving hematological cancer, allogeneic stem cell transplantation, and chemotherapy+TBI were significantly lower in the post-treatment period. According to before chemotherapy period, male patients’ body weight, body mass index, many anthropometric measurements, muscle mass and hand grip strength measurements were significantly lower at the reinfusion, engraftment and post-treatment periods (p <0.05). This decrease was most in the engraftment period. Measurements of body weight and body mass index of female patients were found to be significantly lower in the post-treatment period (p <0.05). In male patients, body weight was significantly lower in hematological cancer patients compared to solid cancer patients, chemotherapy+TBI patients compared to chemotherapy patients and allogeneic stem cell transplant patients compared to autologous stem cell transplant patients at the post-treatment period (p <0,05). Negative energy balance developed in the patients and urinary nitrogen excretion occurred most in the reinfusion phase. However, nutritional support for patients with decreased nutrient intake, especially during the engraftment period, prevented the loss of more nitrogen, and energy, protein intake were completed. In the treatment period,food and nutrients intake of hematologic cancer, allogeneic stem cell transplantation and chemotherapy+TBI patients were affected more negatively; weight and body muscle mass loss had been more. This may be due to the fact that allogeneic stem cell transplantation and chemotherapy plus TBI cause more complications, adversely affect food and nutrient intake, and catabolic effects and toxicity are high treatments. Key Words: hematopoietic stem cell transplantation, nutritional status, anthropometric measurement, body composition, nitrogen balance.