Influence of Malnutrition on the Outcomes of Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients

Background:

Patients with malignancy are more prone to be malnourished due to a combination of factors including the disease process itself, chemotherapy and the associated catabolism. Studies have shown that Protein Energy Malnutrition (PEM) can adversely affect outcomes in hospitalized patients. We aim to study the impact of PEM in Multiple Myeloma patients undergoing Hematopoietic stem cell transplant (HSCT).

Methods:

A retrospective cohort study was designed using data obtained from the 2017 to 2019 combined National Inpatient Sample (NIS) database. Adult patients (age >18) admitted with a principal diagnosis of Multiple Myeloma and a principal procedure of autologous HSCT were identified using the International Diseases Classification code, tenth revision (ICD-10). They were further stratified based on the presence of Protein Energy Malnutrition (PEM). Primary outcomes assessed were, mortality, length of stay (LOS), and Total Hospitalization Charges (THC). Secondary outcomes included a diagnosis of Acute Kidney Injury (AKI), Acute Respiratory Failure (ARF), sepsis, neutropenia, blood transfusion. Multivariate linear and logistic regressions were used to adjust for confounders.

Results:

There was a total of 21,965 adult hospitalizations of MM patients undergoing HSCT and among them 2,955 (0.13%) had a secondary diagnosis of PEM. Those with PEM were older (62 vs 61 p=0.005). The overall mortality was less at 0.007% (N=150) and after adjusting for confounders PEM was associated with an increased odds of mortality, 0.019 vs 0.005% (AOR :3.20, p=0.008, 95% CI: 1.35 - 7.57). There was also an increased LOS in patients with PEM, 19 days vs 16.1 days (adjusted difference of 2.17 days, p=0.000, 95% CI: 1.35 - 2.99), as well as an increase in THC, 221,624 USD vs 195,635 USD (adjusted difference of 17,435 USD, p=0.036, 95% CI: 1173.60 - 33696.16). Similarly, the presence of PEM was associated with an increased odds of several secondary outcomes measured, including anemia (AOR : 1.67, p=0.002, 95% CI: 1.20 - 2.32), intubation (AOR : 4.40, p< 0.001, 95% CI: 2.29 - 8.48) and mechanical ventilation (AOR : 5.10, p< 0.001, 95%CI: 2.63 - 9.90), AKI (AOR : 1.49, p=0.004, 95% CI: 1.14 - 1.95), sepsis (AOR : 2.16, p< 0.001, 95% CI: 1.53 - 3.05), ARF (AOR : 3.39, p< 0.001, 95% CI: 1.99 - 5.75) and pneumonia (AOR : 1.73, p=0.005, 95% CI: 1.18 - 2.53) compared to the other cohort. However, there was no difference in the odds of pressor requirement, neutropenia and UTI between the two groups.

Conclusion:

Presence of PEM leads to poor clinical outcomes. This highlights the importance of addressing nutritional status as an independent prognostic factor. Appetite stimulants, as well as attention to underlying nausea, vomiting, mucositis can improve oral intake and appetite. A multidisciplinary approach with nutritionists, the nursing team, and social work can identify at-risk patients and help improve outcomes.

No relevant conflicts of interest to declare.