Nutritional support in BMT [Supporto metabolico-nutrizionale nel trapianto di midollo osseo]

Bone marrow transplantation (BMT) consists in the administration of high dose chemo-radiotherapy followed by the intravenous infusion of hematopoietic stem cells to restore marrow function. BMT is employed in the management of several diseases, such as solid tumors, hematologic diseases and autoimmune disorders. Artificial Nutrition (AN), in particular total parenteral nutrition (TPN), is routinely used in patients undergoing bone marrow transplantation (BMT) in order to reduce the nutritional sequelae of both BMT conditioning regimens (i.e mucositis of g.i tract) and BMT complications, such as graft versus host disease (GVHD) and veno-occlusive disease (VOD) of the liver. Although AN is presently recognized as a part of standard care for BMT patients, precise guidelines for its use in this clinical setting have not been devised. During the last twenty years, AN in BMT patients has evolved from simple supportive care to adjunctive therapy. Although data exist documenting the positive effect of some nutrients in the management of BMT-recipients, results obtained to date are frequently controversial and still a matter of discussion. Such controversial results are probably due to the lack of homogeneity in the patients studied and study designs. This review focuses on the need to clearly identify the different subgroups of BMT recipients inorder to achieve reproducible and reliable data. It also proposes new therapeutic applications of some nutritional substrates in BMT patients. The need to implement precise guidelines for the use of AN in BMT patients is also underlined.