Pre-Transplant Nutritional Status and Hospitalization Risk in Outpatient HCT: A Prospective Study Using the Patient-Generated Subjective Global Assessment.

Hematopoietic cell transplantation (HCT) is a complex process that impairs nutritional status, resulting in a decrease in body fat and lean mass due to conditioning regimen, prior line of therapy, immunosuppressive therapy, and metabolic alterations that impact appetite and food intake. Bioelectrical impedance (BI) provides objective data on body composition, and instruments such as the Patient-Generated Subjective Global Assessment (PG-SGA) can identify patients with nutritional risk. In our institution, the process of HCT is ambulatory. The patients have an intervention in the nutritional area with nutritional indications, but it is important identify patients with nutritional risk and do and carry out a more intense intervention. Primary objective: cumulative incidence of hospitalization (CIH) according to pre-transplant nutritional status as defined by the PG-SGA. Secondary objectives: cumulative Incidence of infection, non-relapse mortality (NRM), overall survival (OS), and relapse-free survival (RFS). A prospective study was conducted at our outpatient HCT center, aged 18–75 years. Before conditioning, all participants underwent a nutritional evaluation by a licensed nutritionist, which included BI analysis and the PG-SGA. The evaluation was repeated at day +30 (±10) post-transplant. A total of 85 patients have been enrolled, 38% (n = 32) females and 62% (n=53) males. The median age was 45 (IQR 18-72) years. Most patients had a 0-1 ECOG (98%, n = 83), an HCT-CI of 0 (76%, n = 65), and were enrolled after a median of 2 (IQR 1-3) lines of therapy. The most common transplant indication was acute myeloid leukemia (27%, n = 23), followed by acute lymphoid leukemia (26%, n = 22) and multiple myeloma in third (24%, n=25%). HCT type: autologous (42%, n = 36), haploidentical (36%, n = 31). At baseline, 66% were well-nourished and 34% nutritional risk. The 100-day cumulative incidence of hospitalization was significantly higher in malnourished patients compared to well-nourished ones (56% vs. 36%; p = 0.011). In Fine-Gray regression, baseline malnutrition was associated with an increased risk of hospitalization (HR 2.24; 95% CI, 1.22–4.09; p = 0.009). The 100-day cumulative incidence of infection was higher among nutritional risk patients (61% vs 34%, p = 0.03, HR 2.01, 95%CI 1.06-3.81). Significant differences were also observed in 100-day NRM (13% vs. 0%, p = 0.02). One-year OS and RFS were superior in well-nourished (96% vs 70%, p = 0.024, and 91.5% vs 62%, p = 0.006, respectively). At day +30, hospitalized patients exhibited greater fat and muscle mass loss; 53% of well-nourished patients were reclassified as being at nutritional risk. Pre-transplant nutritional status, as determined by PG-SGA, showed a significant association with the need for hospitalization and infections in patients undergoing outpatient HCT.