Nevra KOÇ, Bahattin TUNÇ, Duygu UÇKAN, Betül TAVİL, M Fatih AZIK, Dilek Gürlek GÖKÇEBAY, Eda ÖZAYDIN, Mehmet GÜNDÜZ

Stepwise diet management in pediatric gastrointestinal graft versus host disease

Koç N, Gündüz M, Azık MF, Tavil B, Gürlek-Gökçebay D, Özaydın E, Tunç B, Uçkan D. Stepwise diet management in pediatric gastrointestinal graft versus host disease. Turk J Pediatr 2016; 58: 145-151.Gastrointestinal tract is one of the major systems affected by graft-versus-host disease (GVHD). Injury to the gut during conditioning therapy before stem-cell transplantation (SCT) plays a pivotal role in the initiation of inflammatory stimuli. We reviewed medical records of the patients who underwent SCT between April 2010 and June 2013 in our center. A stepwise upgrade diet was given to the children with acute GI-GVHD (Gastrointestinal GVHD) including parenteral and enteral nutrition. A total of 105 patients underwent SCT and seven patients developed grade III-IV acute GI-GVHD. Total parenteral nutrition (TPN) was initiated to all patients after the diagnosis of GI-GVHD and minimal enteral nutrition (1-2 ml/kg/day standard pediatric enteral formula/special meat soup) was given to the patients. GI-GVHD improved in all patients with no change in body weight, and recovery to a normal diet took 10-30 days. Stepwise diet management of oral nutrition contributed to rapid improvement of grades III-IV acute GI-GVHD.

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1. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versushost disease. Lancet 2009; 373: 1550-1061.
2. Van Der Meij BS, De Graaf P, Wierdsma NJ, et al. Nutritional support in patients with GVHD of the digestive tract: state of the art. Bone Marrow Transplant 2013; 48: 474-482.
3. Akpek G, Chinratanalab W, Lee LA, et al. Gastrointestinal involvement in chronic graft-versus-host disease: a clinicopathologic study. Biol Blood Marrow Transplant 2003; 9: 46-51.
4. Filipovich AH, Weisdorf D, Pavletic S, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945-956.
5. Akbulut G. Gastro-intestinal graft-versus-host disease: A guide for recent dietary therapy: Review. Turkiye Klinikleri J Gastroenterohepatol 2011; 18: 29-37.
6. Flowers ME, Mcdonald G, Carpenter P, et al. Longterm follow-up after hematopoietic stem cell transplant general guidelines for referring physicians. Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Version 4 August 2008: 1-78.
7. Rzepecki P, Barzal J, Oborska S. Blood and marrow transplantation and nutritional support. Support Care Cancer 2010; 18 (Suppl 2): 57-65.
8. Martin-Salces M, De Paz R, Canales MA, Mesejo A, Hernandez-Navarro F. Nutritional recommendations in hematopoietic stem cell transplantation. Nutrition 2008; 24: 769-775.
9. Imataki O, Nakatani S, Hasegawa T, et al. Nutritional support for patients suffering from intestinal graftversus-host disease after allogeneic hematopoietic stem cell transplantation. Am J Hematol 2006; 81: 747-752.
10. Williams DB, Vickers CR. Gastrointestinal complications. In: Kerry Atkinson (ed). Clinical Bone Marrow ND Blood Stem Cell Transplantation (2nd ed), Vol. 69. USA: Cambridge University Press; 2000: 903-909.
11. Merdol TK. The Ministry of Health of Turkey, General Directorate of Primary Health Care, FoodSafety Department Community Nutrition Division. Dietary Guidelines for Turkey. Ankara: Onur Publishing; 2006: 57-65.
12. Cruz-Correa M, Poonawala A, Abraham SC, et al. Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease. Endoscopy 2002, 34: 808-813.
13. Glucksberg H, Storb R, Fefer A, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295-304.
14. Guieze R, Lemal R, Cabrespine A, et al. Enteral versus parenteral nutrition support in allogeneic haematopoietic stem-cell transplantation. Clin Nutr 2014; 33: 533-538.
15. Mattsson J, Westin S, Edlund S, Remberger M. Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease. Bone Marrow Transplant 2006; 38: 629-633.
16. Lenssen P, Aker S. Nutrition Support of the Hematopoietic Cell Transplant Recipient. In: Frederick R. Appelbaum, Stephen J. Forman, Robert S. Negrin, Karl G. Blume (ed). Thomas' Hematopoietic Cell Transplantation: Stem Cell Transplantation (4th ed), Vol. 101. USA: Blackwell Publishing; 2009: 1551-1569.
17. Seguy D, Berthon C, Micol JB, et al. Enteral feeding and early outcomes of patients undergoing allogeneic stem cell transplantation following myeloablative conditioning. Transplantation 2006; 82: 835-839.
18. Svahn BM, Remberger M, Heijbel M, et al. Case-control comparison of at-home and hospital care for allogeneic hematopoietic stem-cell transplantation: the role of oral nutrition. Transplantation 2008; 85: 1000-1007.