Parenteral nutrition support after bone marrow transplantation: Comparisonof total and partial parenteral nutrition during the early posttransplantation period

OBJECTIVE: Bone marrow transplantation (BMT) usually is indicated if the pa tient's malignant disease involves the marrow or if hazard to the normal ma rrow is the limiting factor in the aggressive treatment of disease. The suc cess of BMT depends on a complete team with all the resources needed to ens ure optimal results. Aggressive nutrition support after BMT is very importa nt. Adequate parenteral nutrition, total (TPN) or partial, followed by ente ral nutrition according to the patient's gastrointestinal function. is the important principle. METHODS: Between 1996 and 2000, 60 patients, 46 male and 14 female, receive d BMT in Chang Gung Memorial Hospital. Their ages ranged from 6 to 54 y. St andard TPN was used in 40 patients after BMT, and partial parenteral nutrit ion was used in the remaining 20 patients. TPN was enriched with branched-c hain amino acids (BCAA) when the patient's liver functions were impaired, a nd cyclic TPN was shifted when the patient's liver functions persistently d eteriorated. RESULTS: Most patients improved their nutrition status and increased their body weights, especially those receiving TPN. The patients receiving partia l parenteral nutrition decreased their visceral proteins significantly duri ng the course of parenteral nutrition. The BCAA-TPN can maintain a patient' s visceral protein better than standard TPN. Only two patients expired beca use of graft rejection and sepsis; their body weights and nutrition status showed deterioration despite aggressive nutrition support. CONCLUSIONS: We conclude that the nutrition support for patients with BMT i s related to the success of marrow transplantation. Parenteral nutrition su pport, especially with TPN, is important because of frequent gastrointestin al dysfunction during the posttransplantational period, and it is better at maintaining the nutrition status and body weights of patients after BMT. A n oral. diet can be resumed after the patient's gastrointestinal function h as improved and it can be tolerated. Nutrition 2001;17:773-775. (C) Elsevie r Science Inc. 2001.