Evolução do gasto energético durante o transplante de células-tronco hematopoiéticas em pacientes com doença hematológica e fatores associados

Abstract

Hematopoietic stem cell transplantation is a potentially curative treatment for patients with malignant and non-malignant hematological disorders. Metabolic and nutritional changes are well known, but there is little research assessing the influence of these factors on energy expenditure of patients before and after transplantation, to determine the metabolic demand at different times of treatment. The aim of this research was to investigate the impact of hematopoietic stem cell transplantation (HSCT) on the total energy expenditure of patients with hematological disease and related factors. This is a prospective study carried out in the Bone Marrow Transplant sector at Hospital das Clínicas, Federal University of Minas Gerais (HCUFMG). In the pre-transplant, before the conditioning regime, and also on the 10th and 17th post-transplant, the resting energy expenditure was measured by indirect calorimetry and subsequently adjusted by an activity factor (1.20); clinical outcomes were analyzed between periods D+1 to D+10 and D+11 to D+17; the energy and protein balance was obtained through a 24-hour recall applied at all times evaluated. The analyses were performed in a paired way, to identify changes between pre- and post-transplantation. Twenty patients with an average age of 45.65 ± 17.25 years were evaluated; mostly were men (65%), and the most frequent diagnoses was Chronic Myeloid Leukemia (25%) and Multiple Myeloma (25%). Half of the transplants were allogeneic (60%). Compared to before the transplant, the total energy expenditure increased about 115% to 120% in the post-transplant, and the adjusted energy requirement per kilogram of weight was 28Kcal/Kg in D+10 and 33Kcal/Kg in D+17. Negative energy and protein balance were observed at all times of the study. Fever, mucositis grades III, total number of infectious and non-infectious events, were associated with an increase in total energy expenditure in D+10, in contrast, the pain complaints were related to its decrease. So, we concluded that the total energy expenditure increased compared with before HSCT (28Kcal/Kg, and 33Kcal/Kg in D+10 and D+17, respectively). Fever, mucositis grades I-II, total number of infectious and non-infectious events are associated with an increase in total energy expenditure in D+10, while pain complaints were related to the decrease.