MNT for HCT Flashcards
(15 cards)
Autologous HCT
uses the pt’s own stem cells, collected before the conditioning regimen. After conditioning, the pt’s graft is reinfused to restore hematopoiesis. Primarily used to treat MM, NHL, and HL
Syngeneic HCT
uses stem cells from an identical twin donor
Allogeneic HCT
Uses stem cells from a donor who is fully or closely matched. Used mainly for tx of acute and chronic leukemias, NHL and marrow diseases (aplastic anemia, MDS, myeloproliferative diseases). Donor types can be matched related donor, matched unrelated donor, mismatched unrelated donor, half-matched related donor, umbilical cord blood
Conditioning regimen
preparative regimen given prior to HCT to provide immunoablation. Can include cytotoxic chemo, TBI, or both. 3 types: high dose or myeloablative - combo chemos that ablate bone marrow hematopoiesis and do not allow for autologous reconstitution; pt requires stem cell infusion to rebuild bone marrow. Nonmyeloablative regimens: chemos that cause minimal cytopenias; therefore the pt does not require stem cell infusion. Reduced intensity conditioning: less intensive chemo and/or TBI that causes prolonged cytopenias, requiring stem cell infusion.
Graft vs tumor effect
a response in which the infused graft stem cells attack and kill remaining cancer cells that were not killed by the conditioning chemo to eradicate disease.
dietary guidelines for immunosuppressed pts following HCT
Avoid: raw and undercooked meat, fish, shellfish, poultry, eggs, sausage, and bacon; raw tofu (unless pasteurized or aseptically packaged); lunch meats unless heated until steaming; refrigerated smoked seafood; unpasteurized milk and raw milk products; blue-veined cheeses; uncooked soft cheeses; Mexican-style soft cheeses; pepper jack cheese or other cheeses containing uncooked raw vegetables; fresh salad dressings containing raw eggs or contraindicated cheeses; unwashed raw or frozen fruits and vegetables and those with visible mold; all raw vegetable sprouts; unpasteurized commercial fruit and vegetable juices; well water unless boiled for 15-20 mins and consumed within 48 hours of boiling
Mucositis in HCT pts
can occur in up to 80% of pts undergoing myeloablative conditioning regimens. severe mucositis can occur with TBI + high dose etoposide or melphalan. Methotrexate as GVHD prophylaxis after stem cell infusion can also cause mucositis. Cryotherapy with melphalan can decrease risk. Glutamine not supported at this time.
Sinusoidal Obstructive Syndrome (SOS)
chemo can cause sinusoidal endothelial and hepatocyte damage that triggers a cascade of events leading to narrowing and occluding of hepatic venules, fibrosis, and hepatocyte necrosis -> decreased hepatic outflow, portal HTN, ascites, and hepatomegaly -> multiorgan failure and death. Usually occurs within the first few weeks post HCT. Medical management includes diuresis, sodium restriction, HD, pain management, and use of defibrotide
Typhliltis
neutropenic enterocolitis - GI infection that can occur post transplant - may require gut rest if severe, bland diet if mild
Cytomegalovirus (CMV)
common infection post transplant, can lead to PNA, gastroenteritis, retinitis, and CNS involvement. NIS - CMV enteritis - ulcerations along the GI tract, CMV gastritis, CMV esophagitis, CMV colitis
Acute GVHD
GVHD is a t-cell mediated immunologic reaction to engrafted lymphoid cells against the host tissue. Acute occurs within the first 100 days post HCT. Can affect skin, liver, and GI tract. Gut GVHD is characterized by N/V, severe diarrhea, anorexia, food intolerance, abdominal pain. Symptoms can last weeks to months.
Chronic GVHD
develops later after HCT - associated with N/V/D, mouth pain, dysphagia, dysgeusia, xerostomia, anorexia, early satiety, and wt loss
Diet progression in GVHD
Phase 1: Bowel Rest - NPO and PN
Phase 2: Introduction to oral feeding - isotonic, low residue, low lactose fluids + PN
Phase 3: Introduction of solids - minimal lactose, low fiber, low total acidity, no gastric irritants + PN as needed
Phase 4: Expansion of diet - add foods containing minimal lactose, low fiber, low total acidity, no gastric irritants, if stools indicate fat malabsorption, prescribe a low fat diet + IV repletion prn
Phase 5: Resumption of Regular diet - progress depending on individual tolerance, d/c IV support when oral intake meets nutrient needs
post transplant bone disease
osteoporosis can occur after txp. Ensure adequate calcium and vitamin D intake
