Evaluation of the Success of Prophylactic Enteral Nutrition in Therapeutic Intensification With Autograft of Autologous Hematopoietic Cells in Hematology

University Hospital, Bordeaux200 enrolled

Overview

When the digestive tract is functional, learned societies recommend the use of a nutritional support by enteral feeding. Indeed, it has many advantages (maintenance of gut trophicity, reduction of the risk of infection by reducing the incidence of bacterial translocations,...). It has been used for about fifteen years in hematology departments and offers promising results in the context of allogeneic transplantation with prospective trials in progress (NEPHA study). However, its tolerance has not been studied during autologous transplantation. This study aims to assess the success of enteral nutrition in this setting.

In the literature, there are many studies on the nutritional support to be used during allografts, that highlight the superiority of enteral nutrition over parenteral nutrition in terms of reducing co-morbidities. Enteral nutrition is the nutritional support recommended by learned societies for therapeutic intensification with autograft of autologous hematopoietic cells in hematology. Nevertheless, enteral nutrition presents difficulties in its implementation and failures (refusal of patients, probes vomiting, neutropenic colitis, etc.), requiring the use of parenteral nutrition in case of failure. In this context, the study proposes to assess the success and effectiveness of enteral nutrition.

Study Type

OBSERVATIONAL

Enrollment

200

Conditions

Lymphoma Myeloma

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patient with lymphoma or myeloma * Patient admitted for therapeutic intensification with autologous hematopoietic cells who are eligible for nutritional support by enteral nutrition * Free, informed and written consent signed by the patient Exclusion Criteria: * Refusal of the enteral nutrition * All patients with absolute or enteral nutrition contraindications: * Digestive fistula * Intestinal obstruction * Intestinal ischemia * Active digestive bleeding * Digestive malabsorption (short hail syndrome, bariatric surgery, gastrectomy) * Trauma to the base of the skull or significant deviation of the nasal septum not allowing the insertion of an naso gastric probe. * Esophagitis or barrett's esophagus * Persistent gastro-duodenal dysfunction (gastroparesis) * Patients admitted for autograft for the treatment of conditions other than lymphoma or myeloma (e. g. solid tumours or leukaemia)

Outcomes

Primary Outcomes

Success rate of enteral feeding

Enteral Nutrition will be considered as a success if : TEI / ER \> 70%. On average until recovery from aplasia (or transfer to the intensive care unit or death). TEI : Total Energy Intake (per-os + enteral nutrition + glucose solutions) ER : Energy Requirement (assessed patient needs)

Time frame: From admission to recovery from aplasia (or transfer to the intensive care unit or death)

Secondary Outcomes

Causes of failure of enteral nutrition

All causes of primary or secondary failure that necessitated the cessation of enteral nutrition

Time frame: From admission to recovery from aplasia (an average of 3 weeks)

Evolution of total energy intake

All sources of energy intake (per-os, enteral nutrition, parenteral nutrition, glucose solutions) These will be compared to the estimated needs of patients and expressed as a % of coverage of these needs

Time frame: Every day from admission to discharge (an average of 4 weeks)

Evolution of albuminemia

Blood test carried out on admission and once a week

Time frame: Once a week from admission to discharge (an average of 4 weeks)

Weight evolution

Weighing carried out on admission and on discharge. Will be used to calculate the percentage of weight loss and assess nutritional status