Incidence and Characterization of Taste Disturbances After Allogeneic or Autologous Hematopoietic Stem Cell Transplantation Using Myeloablative or Reduced-Intensity-Conditioning.

Abstract 3319

Poster Board III-207

After hematopoietic stem cell transplantation (HCT) a high incidence of taste and smell alterations is observed which might be associated with delayed physical recovery, general wasting and decreased quality of life. Insufficient nutritional intake can even impair host defense and increase susceptibility to infections. So far, only few systematic evaluations of taste disturbances after HCT have been conducted. We therefore retrospectively analyzed this question using a new standardized questionnaire covering aspects of the dietary pattern and changes in the perception of taste and smell. Clinical data were gathered from patient's charts, and the study was approved by our institutional review board. 181 patients (71 female, 110 male) treated in our institution with a median age of 52 years (range 20-79) were included in the study. The patients completed the questionnaire after a median of 25 months from HCT (range, 1-292). Indications for HCT included acute leukemia =72, myeloproliferative disease =32, lymphoma =29, MDS =10 and other =38. 148 patients received an allogeneic graft after myeloablative conditioning (MAC) (n=87) or reduced-intensitiy-conditioning (RIC) (n=61) and 33 patients were treated with an autologous HCT. 71% of the patients reported moderate to severe changes in taste perception on a semiquantitative visual analogue scale during the acute phase of HCT with no significant differences between the three groups (MAC 74%, RIC 66%, autologous SCT 73%). Changes in smell perception were documented in 54% of patients with a median of 33.5 days (range, 2-365) to improvement. 30% of these patients reported a reduction in smell perception, while 21% described intensification with persistence of these changes in 62% of the patients. In univariate analysis using chi square-tests we examined the difference between autologous and allogeneic transplantation as well as the influence of GvHD or immunosuppression on taste disturbances and loss of weight. Changes in taste perception were significantly associated with loss of body weight > 5kg (69.2% vs. 45.6%, p= 0.002). Alterations in body weight and changes in taste perception tended to be more prevalent after allogeneic SCT compared to after autologous HCT with 45.9% vs. 30.3% and 58.1% vs. 45.5%, respectively. A complete recovery at the time of the survey was reported by 29% of the patients, whereas 26% still suffered from ongoing moderate to severe taste alterations. We observed a significant difference in time to recovery with a subjective improvement of symptoms after a median of 60 days (range, 3-365) after autologous HCT vs. 120 days after allogeneic HCT (range, 30-600) (p= 0.03). The incidence of chronic GVHD was 79/148 (53%) in the patients receiving allogeneic HCT. In patients with cGVHD significantly more patients reported changes in taste perception (64.6% vs. 49.0%, p= 0.04) and loss of body weight > 5kg (55.7% vs 33.3%, p= 0.004). There was a significant association between the use of immunosuppression and taste alterations using tacrolimus (67.2% vs. 50.0%, p= 0.04) or steroids (72.7% vs. 48.4%, p= 0.03) as well as a loss of weight > 5kg using mycophenolatmofetil (53.8% vs. 34.7%, p= 0.01). In conclusion taste and smell disturbances are common events in the early course after HCT. The symptoms persist in one quarter of the patients receiving allogeneic grafts. Interestingly, after allogeneic HCT, no differences between MAC and RIC conditioning but a major impact of GVHD and immunosuppression are observed.