Canterbury DHB

Context

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.

Dietitian education pre-transplant includes the CDHB Safe Eating and Low Immunity Diet Guidelines and appropriate information about levels of nutrition support.

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 BMTU and need to go to IR with the patient.

Prepare patient for the procedure using the Interventional Radiology checklist.

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

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

About this Canterbury DHB document (578278):

Document Owner:

Sean Macpherson (see Who's Who)

Issue Date:

January 2019

Next Review:

January 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 578278