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• The type of nutritional support seems to have relatively minor effects on the post-transplant metabolomic profile. • The metabolic profile of patients treated with standard-care nutritional support indicates an insufficient calorie intake compared with patients treated with individualized enteral nutritional support. Patients undergoing allogeneic stem cell transplantation usually require nutritional support. There is no consensus on whether enteral support through tube feeding should be preferred. A recent randomized study could not detect any difference between enteral and parenteral feeding with regard to post-transplant outcomes, whereas 2 retrospective studies described an association between enteral feeding and a favorable post-transplant outcome. We compared pre- and post-transplant plasma metabolomic profiles for 10 patients receiving mainly enteral nutritional support and 10 patients receiving mainly parenteral support. Samples were collected before conditioning and 3 weeks post-transplant; 824 metabolites were analyzed using mass spectrometry. The pretransplant metabolite profiles showed a significant overlap between the 2 groups. Post-transplant samples for both patient groups showed an increase of secondary bile acids and endocannabinoids, whereas reduced levels were seen for food preservatives, plasmalogens, and retinol metabolites. The main post-transplant differences between the groups were decreased levels of fatty acids and markers of mitochondrial activation in the control group, indicating that these patients had insufficient energy intake. A significant effect was also seen for heme/bilirubin metabolism for the parenteral support. To conclude, allotransplant recipients showed altered metabolic profiles early after transplantation; this was mainly due to the conditioning/transplantation/reconstitution, whereas the type of nutritional support had minor effects. [ABSTRACT FROM AUTHOR]

The outcome of allogeneic hematopoietic stem cell transplantation (HSCT) is influenced by many factors (underlying disease, HLA-matching, patient and donor age, CMV serostatus, co-morbidities, conditioning regimen, GVHD prophylaxis and graft source and composition). The number of T-cells contained in the graft is associated with the incidence and severity of GvHD. The effect of CD34+ cell dose in HSCT on overall survival and incidence of acute and chronic GvHD is less well established. We analyzed transplant outcomes in 189 patients with hematological malignancy and sibling donor receiving G-CSF mobilized peripheral blood stem cell grafts. Myeloablative conditioning was given to 88 patients and reduced intensity conditioning to 101 patients. Median CD34+ cell dose was 5.6 × 106/kg (0.6-17.0). Anti-thymocyte globulin (ATG) was not given. Median time to neutrophil engraftment (ANC >0.5 × 109/L) was 17 days. In multivariate analysis <5 × 106/CD34+ cells/kg correlated to slower engraftment, measured as later than median days-to-engraftment (OR 2.62, 95% CI 1.27-5.41, p=0.008). The 5-year overall survival (OS) for all patients was 47%. The best 5-year OS (71%) was seen in patients receiving 6-7 × 106CD34+cells/kg (HR: 0.43, 95% CI: 0.24-0.78, p=0.005) (fig 1). Transplant related mortality at 1 and 5 years was 19% and 28%, respectively. The lowest TRM (15%) was found among patients given a CD34+ cell dose of 6-7 × 106cells/kg (HR: 0.41, 95% CI: 0.18-0.92, p=0.03). The cumulative incidence of relapse (RI) for all patients was 29%. Increased RI (41%) was found in patients who received <5 × 106cells/kg CD34+ cells (HR: 1.89, 95% CI: 1.09-3.29, p=0.024). In total, 86 (46%) and 92 (56%) patients developed acute and chronic GvHD, respectively. The cumulative incidence of acute GVHD grades II-IV in the whole cohort was 40%. The lowest incidence (33%) of aGVHD II-IV was found among patients receiving a high cell-dose. In the corrected multivariate analysis, a CD34+ cell dose of >6.5 × 106cells/kg was associated with a lower incidence of aGVHD II-IV (RH: 0. 53, 95% CI: 0.29-0.97, p=0.04). In the corrected multivariate analysis a CD34 cell dose of 6-7 × 106/kg was associated with better OS and lower TRM, while a CD34 cell-dose of <5 × 106/kg was associated with more relapse and less cGVHD. A high CD34 cell-dose (>7 × 106/kg) correlated to less aGVHD II-IV. The CD34 cell dose has impact on the outcome in sibling donor HSCT using peripheral-blood stem-cells. [ABSTRACT FROM AUTHOR]

The age of patients admitted to HSCT is increasing. The median age of adult patients is close to 60 years at many centers. With a sibling donor this means that in most cases an older donor will be used. There are reports that donor age is important for the outcome. Our hypothesis is that it may be better to select a young well matched (10/10 match) unrelated donor (MUD), if available, instead of an older matched related donor (MRD). In a homogenous material consisting of patients with myeloid malignancies (AML, MDS, MPN, CML) receiving a PBSC graft and myeloablative conditioning, CsA+MTX as GVHD prophylaxis without in vivo T-cell depletion (no ATG), we studied the effect of the donor age. For this reason we selected patients with a MRD and an older donor (≥40y) and a 10/10 MUD with a younger donor (<40y) for analysis. There were 53 patients with a MRD and 60 with a MUD. Among patients with a MRD the donor age was grouped into three separate categories: 40-50y (n=18), 51-60y (n=23) and >60y (n=12). In the MUD group donor age groups were: 18-25y (n=22) and 26-39y (n=38) (table 1). The best OS, RFS, TRM and GRFS were seen in the "MUD age 18-25y" group (Figure 1). No effect was seen on incidence of relapse and acute and chronic GVHD. In multivariate analysis, corrected for differences between the groups, we found that OS, RFS, TRM and GRFS were better in the "MUD age 18-25y" group, compared to the MRD groups (figure 1). In cases where an older sibling donor is available, it may be reasonable to search for a well-matched young (<25y) MUD. However, this is a limited small, single center study. Larger studies are warranted. [ABSTRACT FROM AUTHOR]