Prolonged anorexia and elevated plasma cytokine levels following myeloablative allogeneic hematopoietic cell transplant

• Published in: Bone marrow transplantation (Basingstoke) Vol. 40; no. 8; pp. 765 - 772
• Main Authors: MALONE, F. R, LEISENRING, W. M, MCDONALD, G. B, STORER, B. E, LAWLER, R, STERN, J. M, AKER, S. N, BOUVIER, M. E, MARTIN, P. J, BATCHELDER, A. L, SCHOCH, H. G
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-10-2007
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anorexia; Anorexia - etiology; Anorexia nervosa; Appetite; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Complications and side effects; Conditioning; Cyclophosphamide - adverse effects; Cytokines; Cytokines - blood; Eating behavior; Energy expenditure; Energy Intake; Energy requirements; Female; Fever; Graft vs Host Disease - etiology; Graft-versus-host reaction; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Interleukin 2; Interleukin 6; Irradiation; Male; Medical sciences; Middle Aged; Patients; Plasma; Plasma cell diseases; Plasma levels; Prospective Studies; Retrospective Studies; Risk factors; Stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - adverse effects; Tumor necrosis factor-α; Whole-Body Irradiation - adverse effects; United States; Immunopathology; Anorexia; acute GVHD; Hematology; Acute; Stem cell; Cytokine; Hematopoietic cell; Homograft; Graft versus host reaction; IL2; Blood plasma; Interleukin 6; tumor necrosis factor-alpha; IL6; Interleukin 2; Immunological investigation; plasma cytokines; Graft; Myelosuppression; Tumor necrosis factor α; Prolonged
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705816

Myeloablative conditioning regimens commonly lead to prolonged anorexia and poor oral intake. In a prospective study of 147 patients receiving CY, total body irradiation and allogeneic hematopoietic cells, we determined the extent of decline in oral intake and assessed plasma cytokine levels and development of acute GVHD as explanations for protracted anorexia. For each patient, daily oral caloric intake was expressed as a percent of estimated basal requirements, calculated as basal energy expenditure, through day 20. Oral caloric intake was significantly reduced in 92% of patients and remained low. The nadir in oral intake occurred at days 10-12, when median oral caloric intake was 3% of basal energy requirements. Plasma cytokines known to affect appetite (IL2, IL6, tumor necrosis factor-alpha) were significantly elevated above normal following conditioning therapy (P<0.001 for each cytokine). Acute GVHD did not appear to affect oral intake to transplant day 20 in this cohort of patients; however, plasma levels of IL6 rose steeply before the clinical onset of GVHD. Persistent fever occurred with the greatest frequency in patients with most profound reduction in oral intake. We conclude that prolonged alterations in oral intake following this myeloablative regimen may be related to circulating cytokines known to alter eating behavior.