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DOI: 10.1055/a-2630-3942
Ernährung während der Therapie von hämatologischen Patienten mit ausgeprägter Immunschwäche
Nutrition under therapy in hematological patients with extensive immunodeficiencyAutor*innen
Zusammenfassung
Patienten mit Erkrankungs- oder Therapie-bedingter Immunsuppression haben ein hohes Risiko für lebensbedrohliche Komplikationen auch durch die Ernährung: durch eine bestehende oder sich durch die Behandlung ausbildende Mangelernährung und durch mögliche lebensmittelbedingte Infektionen. Ernährungstherapeuten sollten frühzeitig hinzugezogen werden und den Patienten regelmäßig und langfristig begleiten. Die Auswahl der Nahrungsmittel ist nicht mehr so bedeutend wie die Lebensmittel-/ Küchenhygiene, wobei die Beeinflussung des Darmmikrobioms durch die Ernährung noch weiterer Untersuchungen bedarf. Eine frühe Ernährungstherapie in Kombination mit Bewegungstherapie ist essentiell, um die Lebensqualität und Prognose von Patienten mit den hier diskutieren Erkrankungen und Therapien zu verbessern.
Abstract
Hematological patients with intensive immunodeficiency have two main nutritional problems: malnutrition and food-borne infections. After diagnosis malnutrition should be addressed with intensive nutritional counselling and early initiation of oral, enteral, or parenteral nutrition. To avoid infections food and kitchen hygiene are most important in prevention. Nutrition and the gut microbiome are discussed as well special situation after hematopoietic cell transplantation. Early nutrition intervention in combination with exercise therapy is essential to improve quality of life and outcome in the discussed diagnoses and procedures.
Publikationsverlauf
Eingereicht: 09. März 2025
Angenommen: 27. April 2025
Artikel online veröffentlicht:
05. Dezember 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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Literatur
- 1 Arends J, Bachmann P, Baracos V. et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017; 36: 11-48
- 2 McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: A decade of experience in patients with cancer. Cancer Treat Rev 2013; 39: 534-540
- 3 Witte HM, Bonorden B, Riecke A. et al. The Glasgow Prognostic Score at Diagnosis Is a Predictor of Clinical Outcome in Patients with Multiple Myeloma Undergoing Autologous Haematopoietic Stem Cell Transplantation. Cancers 2020; 12: 921
- 4 Schaffrath J, Diederichs T, Unverzagt S. et al. Correlation of nutrition-associated parameters with non-relapse mortality in allogeneic hematopoietic stem cell transplantation. Ann Hematol 2022; 101: 681-691
- 5 Urbain P, Birlinger J, Lambert C. et al. Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2013; 48: 446-451
- 6 Sorror ML, Maris MB, Storb R. et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912-2919
- 7 Le Blanc K, Ringdén O, Remberger M. A low body mass index is correlated with poor survival after allogeneic stem cell transplantation. Haematologica 2003; 88: 1044-1052
- 8 Schaffrath J, Diederichs T, Unverzagt S. et al. Correlation of nutrition-associated parameters with non-relapse mortality in allogeneic hematopoietic stem cell transplantation. Ann Hematol 2022; 101: 681-691
- 9 Rejeski K, Cordas Dos Santos DM, Parker NH. et al. Influence of Adipose Tissue Distribution, Sarcopenia, and Nutritional Status on Clinical Outcomes After CD19 CAR T-cell Therapy. Cancer Immunol Res 2023; 11: 707-719
- 10 Ito Y, Honda A, Kurokawa M. Impact of vitamin D level at diagnosis and transplantation on the prognosis of hematological malignancy: a meta-analysis. Blood Adv 2022; 6: 1499-1511
- 11 Gardner A, Mattiuzzi G, Faderl S. et al. Randomized Comparison of Cooked and Noncooked Diets in Patients Undergoing Remission Induction Therapy for Acute Myeloid Leukemia. J Clin Oncol 2008; 26: 5684-5688
- 12 RKI. Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2021; 64: 232-264
- 13 Andersen S, Xu J, Llewellyn S. et al. Nutrition support and clinical outcomes following allogeneic stem cell transplantation. Bone Marrow Transplant 2023; 58: 1137-1142
- 14 Seguy D, Duhamel A, Rejeb MB. et al. Better Outcome of Patients Undergoing Enteral Tube Feeding After Myeloablative Conditioning for Allogeneic Stem Cell Transplantation. Transplantation 2012; 94: 287-294
- 15 Andersen S, Fichera R, Banks M. et al. Proactive enteral nutrition for patients undergoing allogeneic stem cell transplantation- implementation and clinical outcomes. Eur J Clin Nutr 2023;
- 16 Seguy D, Hueso T. Nutritional interventions in patients with graft-versus-host disease. Curr Opin Clin Nutr Metab Care 2023; 26: 455-462
- 17 Zama D, Muratore E, Biagi E. et al. Enteral nutrition protects children undergoing allogeneic hematopoietic stem cell transplantation from blood stream infections. Nutr J 2020; 19: 29
- 18 McMillen KK, Coghlin-Dickson T, Adintori PA. Optimization of nutrition support practices early after hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56: 314-326
- 19 Andersen S, Staudacher H, Weber N. et al. Pilot study investigating the effect of enteral and parenteral nutrition on the gastrointestinal microbiome post-allogeneic transplantation. Br J Haematol 2020; 188: 570-581
- 20 Metafuni E, Di Marino L, Giammarco S. et al. The Role of Fecal Microbiota Transplantation in the Allogeneic Stem Cell Transplant Setting. Microorganisms 2023; 11: 2182
- 21 Limpert R, Pan P, Wang L-S. et al. From support to therapy: rethinking the role of nutrition in acute graft-versus-host disease. Front Immunol 2023; 14: 1192084
- 22 Lakshmanan AP, Deola S, Terranegra A. The Promise of Precision Nutrition for Modulation of the Gut Microbiota as a Novel Therapeutic Approach to Acute Graft-versus-host Disease. Transplantation 2023; 107: 2497-2509
- 23 Muratore E, Leardini D, Baccelli F. et al. Nutritional modulation of the gut microbiome in allogeneic hematopoietic stem cell transplantation recipients. Front Nutr 2022; 9: 993668
- 24 Morello E, Brambilla G, Bernardi S. et al. Nutritional intervention with TGF-beta enriched food for special medical purposes (TGF-FSMP) is associated with a reduction of malnutrition, acute GVHD, pneumonia and may improve overall survival in patients undergoing allogeneic hematopoietic stem transplantation. Transpl Immunol 2023; 81: 101954
- 25 foodsafety.gov. A federal government website managed by the U.S. Department of Health & Human Services 4 Steps to Food Safety (18.09.2023). Zugriff am: 27.04.2025 unter https://www.foodsafety.gov/keep-food-safe/4-steps-to-food-safety
- 26 Verbraucherportal Bayern. Sieben Hauptregeln zum hygienischen Umgang mit Lebensmitteln (04.09.2024). Zugriff am 27.04.2025 unter https://www.vis.bayern.de/essen_trinken/hygiene_technologie/7regeln.htm
- 27 Dennett AM, Porter J, Ting SB. et al. Prehabilitation to improve function after autologous stem cell transplantation: A pilot randomized controlled trial (PIRATE. Support Care Cancer 2025; 33: 164
- 28 Wiskemann J, Dreger P, Schwerdtfeger R. et al. Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 2011; 117: 2604-2613
