Nutrition support for patients undergoing an Allogeneic Stem Cell Transplant

Refer all patients planned for an allogeneic stem cell transplant to the Dietitian before admission for nutritional assessment. Any risk factors or concerns are discussed with the transplant coordinators and medical team.

Oral diet

Enteral nutrition

A nasojejunal tube (NJ) is recommended for all patients receiving an allogeneic stem cell transplant where the conditioning chemotherapy is considered myeloablative or standard.

Patients receiving a reduced intensity conditioning chemotherapy such as Flu/Bu/ATG where the side effects are significantly reduced may avoid prophylactic insertion of an NJ tube if:

Consider nutrition support during the admission if weight loss is greater than 5%.

If a clinical decision is made to proceed with enteral feeding, the ideal insertion time of the feeding tube is D-3 to D+3 of the transplant.

The preferred NJ tube is a 10F enteral feeding tube. These are kept on B6 and need to go to IR with the patient.

Enteral feeding should continue until the patient is able to consume 50% of their nutritional requirements orally.

See Guidelines for inserting enteral feeding tubes for patients undergoing allogeneic transplants.

Parenteral nutrition

Indicated in allogeneic patients consuming < 50% of their nutrition requirements who are not likely to improve within 5–7 days where the enteral route cannot be used e.g., severe mucositis or Graft versus Host Disease (GvHD).

Gastronintestinal GvHD Diet Progression


About this Canterbury DHB document (578278):
Document Owner:	Sean Macpherson (see Who's Who)
Last Reviewed:	January 2019
Next Review:	January 2022
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Phase	Symptoms/Progress	Nutrition Support
Phase 4	Cramping/pain Large volumes of diarrhoea >500 mL/day	Total gut rest Nil by mouth Parenteral nutrition and IV fluids
Phase 3	Symptoms improving Diarrhoea volumes <500 mL/day	Clear fluid diet Parenteral nutrition and IV fluids to continue
Phase 2	Tolerating phase 3 diet Stools are brown	Low residue diet Small meals and snacks 2 hourly Parenteral nutrition and IV fluids continue/reducing
Phase 1	Tolerating phase 2 diet Stools are formed Managing 50% of nutrition requirements orally	Normal diet (low immunity if required) Wean off supplemental parenteral nutrition and IV fluids