Nutritional modulation and support for pediatric patients with cancer and undergoing hematopoietic cell transplantation

Nutritional status has been demonstrated as a crucial aspect in the treatment of pediatric oncology patients, with measurable impact of morbidity and mortality in children with acute leukemias. Thus, great effort should be made to optimize nutritional evaluation and support. In fact, in pediatric patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT), nutritional support (e.g. enteral nutrition) can be effectively utilized to reduce the incidence of bloodstream infections (BSI). Furthermore, nutritional interventions can be utilized to modulate the gut microbiome (GM) configuration, which has implications for severe HCT-related complications such as acute graft-vs-host disease (GvHD). Other interventional strategies including fecal microbiota transplantation (FMT), can be utilized to modify the GM configurations. In this thesis, we summarize the results of two nationwide survey among the Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIOEP) network aimed to assess the current practices for nutritional evaluation and care, as well as food-handling practices and foodborne infections among pediatric patients undergoing chemotherapy and allo-HCT. Moreover, we compared nutritional and HCT-related outcomes (such as acute GvHD and BSI) in a cohort of pediatric patients undergoing allogeneic HCT between patients receiving nutritional support with Parenteral Nutrition (PN) and Enteral Nutrition (EN). Finally, we evaluate the feasibility and safety of FMT in a cohort of children with steroid-refractory gut GvHD and MDR colonization, observing an exceptional safety profile and clinical response.