Comparison of pre- and post-transplant Energy Expenditure in patients undergoing Hematopoietic Stem Cell Transplantation and evaluation of associated factors

Patients undergoing hematopoietic stem cell transplantation (HSCT) may present with metabolic alterations that can impact their energy expenditure (EE) and nutritional status. This project aimed to compare the pre- and post-transplant EE of patients undergoing HSCT, as well as related factors. This prospective study was conducted at a single center. Patients, undergoing autograft or allograft, were evaluated before transplantation and on 10th and 17th days post-transplantation. EE was measured by indirect calorimetry. Diet intake was assessed by a 24-hour dietary recall. Infectious and noninfectious complications were analyzed between days D+1 to D+10 and D+11 to D+17. Paired model analyses were carried out to identify the pre-transplantation and post-transplantation periods. Twenty patients were evaluated with a mean age of 45.6 ± 17.2 years; the majority was male sex (65%), and the most frequent diagnoses were chronic myeloid leukemia (25%) and multiple myeloma (25%). EE increased by 15% post-transplantation, and the energy requirement per kilogram of weight was 23 kcal/kg at D+10. Throughout the post-transplantation period 45% of the patients required nutritional therapy. Negative energy and protein balance were observed at all analyzed times. Phase angle (p=0.018), fever (p=0.014), mucositis grades I-II (p=0.018), and the total number of infectious and noninfectious events (p=0.043) were associated with an increase in energy expenditure at D+10. EE increased after transplantation compared to pre-transplantation in 50% of patients. Phase angle, fever, grade I-II mucositis, infectious and noninfectious events were associated with increased energy expenditure at D+10. Registration on 06/13/2019: NCT04535570.