Chronic Graft-Versus-Host Disease and Unintentional Weight Loss

Clinical Significance and Mortality Risk

The National Comprehensive Cancer Network recognizes weight loss as a late complication of hematopoietic stem cell transplantation (HSCT) in survivors with cGVHD, which directly impacts patient outcomes 1
cGVHD is the leading cause of non-relapse mortality in HSCT survivors, with weight loss and malnutrition representing potential independent risk factors for mortality 1

Multiple factors contribute to muscle weakness and muscle loss in cGVHD patients, including the underlying malignant disease, pre-HSCT therapy, immobilization during HSCT, and side effects of corticosteroids used to treat cGVHD 2, 3

Severe mucositis, intractable vomiting, ileus, severe malabsorption, and protracted diarrhea are all manifestations of cGVHD that directly impair nutritional intake 2, 4
Patients with cGVHD lose weight particularly in the first 40 days after admission for HSCT, with weight loss having a negative effect on clinical outcomes 2, 4

Patients should be screened and assessed for impending or overt malnutrition at admission and monitored weekly during HSCT for adequate nutrient intake, metabolism, and physical activity 2, 4
If nutritional deficits are observed, nutrition support including counseling, oral nutritional supplements (ONS), enteral nutrition (EN), and/or parenteral nutrition (PN) should be initiated early to avoid or minimize further loss of weight and body cell mass 2, 4
Enteral tube feeding is preferred over parenteral nutrition unless there is severe mucositis, intractable vomiting, ileus, severe malabsorption, protracted diarrhea, or symptomatic gastrointestinal graft-versus-host disease 2, 4, 5
Patients should be encouraged and supported to perform muscle training and increase physical activity before, during, and after HSCT to improve outcomes 2, 3

Delaying nutritional intervention can lead to further deterioration, and early initiation of nutrition support is critical 2, 4
Metabolic disturbances from cGVHD may prevent substantial benefit from nutritional support alone, and controlling the underlying disease may be necessary to reverse malnutrition 6