Rev. Bras. Hematol. Hemoter. vol.39 número4

rev bras hematol hemoter. 2017;39(4):297–298

w w w . r b h h . o r g

Revista

Brasileira

de

Hematologia

e

Hemoterapia

Brazilian

Journal

of

Hematology

and

Hemotherapy

Scientific

Comment

Body

composition

assessment

in

hematopoietic

stem

cell

transplantation

夽

Masumi

Ueda

ClinicalResearchDivision,FredHutchinsonCancerResearchCenter,Seattle,USA

Nutritionalstatusisanimportantfactorinfluencingoutcomes inpersonsundergoinghematopoieticstemcell transplanta-tion(HSCT).Whilequantitativemeasurementssuchasbody massindex(BMI)andweightchangeandserummarkerssuch asalbuminarecommonlyusedinthepre-andpost-transplant evaluations,theseparametersinisolationgiveanincomplete understandingofoverallhealthstatus.Amorecomprehensive evaluationofbodycompositionanditsrelationtofunctional statuspre- and post-transplant would facilitatethe imple-mentationofinterventions aimed toimprove outcomes in transplantrecipients.

Priorstudiesofallogeneictransplantrecipientshave iden-tified low BMI, low body weight, or weight loss during transplant as measurements ofnutritional status correlat-ingwithinferiorclinicaloutcomes.1_{Lowpre-transplantBMI}

<18.5kg/m2_{hasbeenassociatedwithworsesurvival,higher}

treatment-relatedmortalityandinsomeinstanceshigherrisk ofdisease relapse.2 _{Other studies indicate that the}

major-ity of transplant recipients experience 5–10% decreases in pre-transplant BMIor body weight after transplant,3 _likely

attributedtoacutetoxicitiesoftransplantconditioning regi-mens or complications such as graft-versus-host disease. While such studies are limited by observational or ret-rospective study design, the available data indicates that malnutritionbeforeand aftertransplant isassociatedwith adverseoutcomes.

DOIoforiginalarticle:http://dx.doi.org/10.1016/j.bjhh.2017.06.004.

夽

SeepaperbySilvaetal.onpages318–24.

∗ _{Correspondenceto:ClinicalResearchDivision,FredHutchinsonCancerResearchCenter,1100FairviewAveN.,D1-100,Seattle,WA98109,}

USA.

E-mailaddress:mueda@fredhutch.org

Fewstudieshaveanalyzedbodycompositionandits asso-ciationwithtransplantoutcomes.Bodycompositionrefersto therelativepercentagesoffat,muscle,water,andboneinthe humanbody.Assuch, informationon bodycompositionin additiontoparameterssuchasBMIandalbuminmayoffer a morecomplete picture ofthe physical statusbefore and aftertransplant.Variousmethodsareavailableformeasuring bodycomposition;however,themostappropriateor mean-ingfultestinaparticularclinicalsettingislargelyunknown. Forexample,inalongitudinalstudyofpediatricpatientswho receivedallogeneicHSCTforhematologicmalignancies,BMI andleanbodymass(LBM)asmeasuredbywholebody dual-energyX-rayabsorptiometry(DXA)declinedsignificantlyover timeafterallogeneicHSCT.4_{However,inthesamestudy,body}

fatpercentageremainedatthepopulationlevel,emphasizing theneedtoconsidermultipleparameterswhenassessingthe nutritionalstatusoftransplantrecipients.Fat-freemasshas been correlatedwithbetterfunctionalcapacityasassessed byobjectivemeasuressuchasthesix-minutewalktestand pulmonaryfunctionstudies.2_{Lowarmmuscleareameasured}

pre-HSCThasbeen associatedwith180-daymortality post-transplant.5_{Otherstudieshaveevaluatedupper-limbmuscle}

strength,air-displacementplethysmorgraphyand bioelectri-calimpedanceanalysis(BIA)withstandardizedphaseangle inlong-term follow-upofallo-HSCT recipients6–8_{; however,}

suchstudiesrequirefurthervalidationandstandardizationin

https://doi.org/10.1016/j.bjhh.2017.08.003

298

largernumbersofpatientsindisease-andage-specific sett-ings.

InthisissueoftheRevistaBrasileiradeHematologiae Hemoter-apia,daSilvaetal.presentdatafromacross-sectionalstudy evaluatingadiversesetofbody compositionparametersin Fanconi Anemia patients aged 2–40 years, most of whom underwent HSCT.9 _{The authors assessed BMI, referenced}

according to age in children and adolescents, and LBM of transplantrecipientsatvariouslengthsoffollow-up(0.5–27 years).Theyalsoanalyzedavarietyofcomplimentary assess-menttools:tricepsskinfold(TSF),armcircumference(AC), arm muscle area (AMA),and BIA with astandardized cal-culation for phase angle. Theauthors found muscle mass depletionbasedonAMAinatleasthalfofallsubjects.In addi-tion,underweightcomparedtothereferencepopulationwasa frequentfindinginadultsbutnotinchildrenandadolescents, andshortstaturewascommoninchildrenandadolescents. LBMandphaseanglemeasurementbasedonBIAwassimilar acrossallagegroups.

While this is primarily a descriptive study, the authors should be commended for their comprehensive approach to body composition measurements in this population, in which endocrine issues may persist many years post-transplant.Establishing areferenceofbodycomposition in disease-specificandage-specificpopulationsbeforeandafter transplantisgreatlyneeded.Toworktowardsabetter under-standingofbodycompositionparametersmorepredictiveof clinical outcomes is an importantendeavor. In the future, interventionsdirectedatmodifyingsuchparameters– includ-ingnutritional,behavioral,andexerciseinterventions–will likelyyieldmoresuccessinsurvivorship,returntoworkand otheractivitiesindicativeofaproductivelifeaftertransplant.

Conflicts

of

interest

Theauthordeclaresnoconflictsofinterest.

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2.BaumgartnerA,BargetziA,ZuegerN,BargetziM,MedingerM, BounoureL,etal.Revisitingnutritionalsupportforallogeneic hematologicstemcelltransplantation–asystematicreview. BoneMarrowTransplant.2017;52(4):506–13.

3.UrbainP,BirlingerJ,LambertC,FinkeJ,BertzH,BiesalskiHK. Longitudinalfollow-upofnutritionalstatusanditsinfluencing factorsinadultsundergoingallogeneichematopoieticcell transplantation.BoneMarrowTransplant.2013;48(3):446–51.

4.InabaH,YangJ,KasteSC,HartfordCM,MotosueMS, ChemaitillyW,etal.Longitudinalchangesinbodymassand compositioninsurvivorsofchildhoodhematologic

malignanciesafterallogeneichematopoieticstem-cell transplantation.JClinOncol.2012;30(32):3991–7.

5.ThomazAC,SilverioCI,CamposDJ,KieutekaEE,RabitoEI, FunkeVA,etal.Pre-transplantarmmusclearea:asimple measuretoidentifypatientsatrisk.SupportCareCancer. 2015;23(11):3385–91.

6.BrotelleT,LemalR,CabrespineA,CombalC,HermetE,Ravinet A,etal.Prevalenceofmalnutritioninadultpatientspreviously treatedwithallogeneichematopoieticstem-cell

transplantation.ClinNutr.2017.pii:S0261-5614(17)30107-3.

7.HungYC,BauerJD,HorselyP,WardLC,BashfordJ,IsenringEA. Bodycompositionfollowingstemcelltransplant:comparison ofbioimpedanceandair-displacementplethysmography. Nutrition.2014;30(9):1000–6.

8.FariasCL,CamposDJ,BonfinCM,VilelaRM.Phaseanglefrom BIAasaprognosticandnutritionalstatustoolforchildrenand adolescentsundergoinghematopoieticstemcell

transplantation.ClinNutr.2013;32(3):420–5.