Predictive effects of malnutrition indicators for morbidity and mortality among blood and marrow transplantation recipients: A retrospective chart review

The purpose of this study was to identify complications related to the blood and marrow transplantation (BMT) process, the presence of malnutrition among patients who received myeloablative allogeneic BMT, and the predictive effects of malnutrition indicators to the outcomes of BMT. Four research questions related to malnutrition were investigated: (a) malnutrition indicators and outcomes of BMT; (b) body mass index (BMI) and incidences of transplant related mortality; (c) degree of mucositis and its relationship to transplant related infections; and (d) predictive ability of BMI and serum albumin levels and infection incidences during 100 days post BMT. The conceptual framework chosen for this study is based on the pathways of cancer aggression (1977) which demonstrate how cancer interferes with multiple organs and function leading to host depletion, morbidity, and mortality. This study is a retrospective chart review from 110 electronic medical records of patients diagnosed with Acute Myeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS), who received the same regimen of myeloablative, allogeneic BMT from one cancer institution during August 2005 to June 2008. Findings revealed that there were subjects who experienced weight loss (68%) and had hypoalbuminemia (97.3%), indicating malnutrition among 110 post-allogeneic BMT recipients during the 100 days post-BMT. Weight loss was not related to transplant mortality but it significantly contributed to an increase in transplant related infections. Hypoalbuminemia was significantly related to both transplant related mortality and infection especially when serum albumin dropped below 3 gm/dL. The body mass index was not related to transplant related mortality during 100 days post BMT. Although the majority of subjects (71.8%) experienced mucositis to the point that it interfered their eating and swallowing solid food, severity in mucositis did not contribute to transplant related infection. Both BMI and hypoalbuminemia were significant predictors to transplant related infection during 100 days post BMT.