RESUMEN
Graft-versus-host disease (GVHD) is the most common complication after allogeneic hematopoietic cell transplantation (allo-HCT) with a frequency range of 30% to 50%. GVH is the leading cause of non-relapse-related deaths and a cause early mortality. Gastro-intestinal (GI) GVH results in digestive manifestations that involve the small intestine and the colon. The patient may then have diarrhea, intestinal bleeding, abdominal pain but also clinical signs such as nausea and vomiting may lead to anorexia. GI-GVHD promotes undernutrition as well as significant losses of vitamins and trace elements. In the case of post-transplant diarrhea, differential diagnosis can include GI-GVHD, infection and drug toxicity. Although, corticosteroids w/wo calcineurin inhibitors represent the standard of care in first line treatment, there is no consensus regarding salvage therapy in case of corticoresistant GI-GVH. In addition, assessment of early nutritional status would help combating undernutrition, which is an independent risk factor for mortality in patients with GI-GVHD. In this workshop of the Fancophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) we focused on the management of patients developing GI-GVHD following allo-HCT.
Asunto(s)
Enfermedades Gastrointestinales , Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Complicaciones Posoperatorias , Corticoesteroides/uso terapéutico , Diagnóstico Diferencial , Diarrea/etiología , Resistencia a Medicamentos , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/terapia , Enfermedad Injerto contra Huésped/complicaciones , Enfermedad Injerto contra Huésped/diagnóstico , Enfermedad Injerto contra Huésped/terapia , Humanos , Estado Nutricional , Apoyo Nutricional , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Terapia RecuperativaRESUMEN
Given the absence of consensus on oral feeding of patients undergoing allogeneic hematopoietic transplantation, the ninth workshops of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) allocated one session to address this topic, especially during the hospitalization. A questionnaire was sent to all SFGM-TC pediatric and adult centers in order to investigate oral feeding practices. The results demonstrated a large disparity among centers regarding oral feeding. Here, we report our recommendations regarding the oral feeding after allogeneic hematopoietic cell transplantation in terms of quality, quantity and bacterial authorized load.