Corinne Bouteloup

Immunonutrition improves functional capacities in head and neck and esophageal cancer patients undergoing radiochemotherapy: A randomized clinical trial

BACKGROUND & AIMS Malnutrition is frequent in head and neck (HN) and esophageal cancer patients and aggravated by radiochemotherapy (RCT), increasing morbi-mortality and treatment toxicity. Our goal was to investigate the effect of immunonutrition consisting of an arginine, omega-3 fatty acid, nucleotides-enriched diet on nutritional status, and functional capacity in HN or esophageal cancer patients undergoing RCT. METHODS 37 patients were randomized in a double-blind clinical trial. 5 days before and until the end of RCT (5-7 weeks), they received either an Immunomodulating Enteral Nutrition (IEN) or an isonitrogenous, isoenergetic Standard Enteral Nutrition (SEN). Anthropometrical parameters, nutritional risk index (NRI), serum albumin, plasma antioxidant capacity, and functional capacity were recorded between the beginning and the end of RCT. RESULTS A significant gain in total body weight (+2.1 ± 3.1 kg) was observed in IEN patients. Albuminemia and NRI were improved concomitantly in IEN malnourished patients. Plasma antioxidant capacity was improved (+100 ± 13 μM EqTrolox) in IEN patients. Functional capacity measured by WHO Performance Status and Karnofsky index was maintained in IEN patients but significantly reduced in SEN patients. CONCLUSIONS These preliminary data show that immunonutrition could improve the nutritional status together with functional capacity in HN and esophageal cancer patients undergoing RCT. CLINICAL TRIAL REGISTRATION This clinical trial promoted by the University Hospital Center of Clermont-Ferrand has been registered at ClinicalTrial.gov website under the following reference: NCT00333099.

Enteral versus parenteral nutritional support in allogeneic haematopoietic stem-cell transplantation

BACKGROUND Allogeneic haematopoietic stem-cell transplantation (allo-HSCT) is associated with frequent and severe malnutrition, which may contribute to transplant-related morbidity. While both enteral nutrition (EN) via a nasogastric tube and parenteral nutrition (PN) are effective, it remains unclear what is the optimal method of nutritional support. AIMS We propose to compare the impact of EN versus PN on early outcome after allo-HSCT. METHODS We evaluated the effect of initial nutritional support with EN versus PN on early outcome in 56 patients who required nutritional support after first allo-HSCT for haematological malignancies in our centre. Patients were offered EN but could decline and chose to be treated by PN. RESULTS Twenty patients received myeloablative conditioning and 36 received reduced-intensity conditioning. Twenty-eight patients received EN and 28 received PN. Compared with PN, EN was associated with a lower median duration of fever (2 versus 5 days; p < 0.01), a reduced need for empirical antifungal therapy (7 versus 17 patients; p < 0.01), a lower rate of central venous catheter replacement (9 versus 3 patients; p = 0.051) and a lower rate of transfer to intensive care (2 versus 8 patients; p = 0.036). The early death rate (<100 days) was the same in both groups (14%). CONCLUSIONS Compared with PN, EN was associated with a lower risk of infection in allo-HSCT, without an increase in the incidence of graft-versus-host disease.

Could enteral nutrition improve the outcome of patients with haematological malignancies undergoing allogeneic haematopoietic stem cell transplantation? A study protocol for a randomized controlled trial (the NEPHA study)

BackgroundMyeloablative allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a major procedure usually accompanied by multifactorial malnutrition, prompting the recommendation of systematic artificial nutritional support. Parenteral nutrition (PN) is usually administered during allo-HSCT, essentially for practical reasons. Recently published data suggest that enteral nutrition (EN), given as systematic artificial nutrition support, could decrease grade III–IV graft-versus-host disease (GVHD) and infectious events, which are associated with early toxicity after allo-HSCT and then have an impact on early transplant-related mortality (D100 mortality).Methods/DesignWe report on the NEPHA trial: an open-label, prospective, randomised, multi-centre study on two parallel groups, which has been designed to evaluate the effect of EN compared to PN on early toxicity after an allo-HSCT procedure. Two hundred forty patients treated with allo-HSCT for a haematological malignancy will be randomly assigned to two groups to receive either EN or PN. The primary endpoint will assess the effect of EN on D100 mortality. Secondary endpoints will compare EN and PN with regards to the main haematological, infectious and nutritional outcomes.DiscussionThe impacts of nutritional support should exceed the limits of nutritional status improvement: EN may directly reduce immunological and infectious events, as well as decrease early transplant-related morbidity and mortality. EN and PN need to be prospectively compared in order to assess their impacts and to provide treatment guidelines. (Clinical trials gov number: NCT01955772; registration: July 19th, 2013).

Immunonutrition stimulates immune functions and antioxidant defense capacities of leukocytes in radiochemotherapy-treated head & neck and esophageal cancer patients: A double-blind randomized clinical trial

BACKGROUND Immunonutrition has been reported to improve the immune status of perioperative cancer patients, thereby reducing complications and length of hospital stay. AIM This study aimed to assess whether immunonutrition enriched in arginine, EPA & DHA and nucleotides could impact the immune cells responses in head & neck and esophageal cancer patients treated by radiochemotherapy (RCT). METHODS A double-blind clinical trial was carried out in 28 patients randomized into two groups, receiving either an immunomodulating enteral nutrition formula (IEN, n = 13, Impact(®), Nestlé) or an isoenergetic isonitrogenous standard enteral nutrition formula (SEN, n = 15) throughout RCT (5-7 weeks). After isolation from whole blood, immune cells metabolism and functions were assessed at the beginning (Db) and at the end (De) of RCT. RESULTS Immunonutrition maintained CD4(+)/CD8(+) T-lymphocyte counts ratio and CD3 membrane expression between Db and De. Polymorphonuclear cells CD62L and CD15 densities and ROS production were increased in IEN patients. Peripheral blood mononuclear cells (PBMC) production of pro-inflammatory prostaglandin-E2 was stable in IEN patients and lower than in SEN patients at De. Genes coding for immune receptors, antioxidant enzymes and NADPH oxidase subunits were overexpressed in the PBMC of IEN vs SEN patients at De. CONCLUSION Immunonutrition can enhance immune cell responses through the modulation of their phenotypes and functions. By modulating the gene expression of immune cells, immunonutrition could make it easier for the organism to adapt to the systemic inflammation and oxidative stress induced by RCT. CLINICAL TRIAL REGISTRATION This clinical trial has been registered on ClinicalTrial.gov website: NCT00333099.

P081: Répartition des indications de la Nutrition Entérale à Domicile (NED) chez l’adulte en France (étude préliminaire)

Introduction et but de l’etude Les taux d’incidence et de prevalence de la NED chez l’Adulte (>15ans) en France sont connus (*) (respectivement 33,6 et 75,2/100 000 habitants/an) et variables avec l’âge (x2 apres 40 ans). Toutefois la repartition des indications medicales reste indeterminee. Materiel et methodes Selon la methode utilisee precedemment (*) et grâce aux codes de la Liste des Produits et Prestations (LPP), il a ete demande aux Directions Regionales du Service Medical de l’Assurance Maladie (DRSM) de l’ensemble du territoire de communiquer le nombre de patients pris en charge en NED en 2012, et de croiser ces resultats avec les fichiers d’Affection de Longue duree (ALD). Les patients ont ensuite ete regroupes en 5 categories (Cancerologie, Neurologie, Insuffisance d’Organe, Affection Digestive, Autres) et en 3 tranches d’âge (15 a 39 ans, 40 a 69 ans, 70 a 99 ans). Resultats et Analyse statistique 7 DRSM ont repondu (Auvergne, Bourgogne - Franche-Comte, Bretagne, Limousin, Nord-Pas de calais-Picardie, Poitou-Charentes, Reunion) correspondant a 9 regions et a 10,8 millions d’habitants. Les resultats sont donnes en pourcentage du nombre d’ALD. Cancero (%) Neuro (%) Digestif (%) Insuf Organe (%) Autres (%) 15 a 39 ans 10,9 55,9 11,8 10,4 11,0 40 a 69 ans 53,1 19,5 0,9 16,6 9,8 70 a 99 ans 37,2 24,6 0,3 23,5 14,5 Total >15 ans 44,4 24,6 1,9 17,3 11,2 Conclusion Les indications de NED sont dominees par les cancers et les affections neurologiques avec des repartitions differentes selon les tranches d’âge. Les affections digestives sont limitees aux maladies inflammatoires chroniques intestinales et representent 11, 8 % des indications entre 15 et 39 ans. Les limites de ces resultats sont liees au fait que 30,5 % des patients (respectivement 2,2 %, 31,2 %, et 44,5 % selon les 3 tranches d’âge) ont declare plusieurs ALD.

P324: Répartition des indications de la Nutrition Entérale à Domicile (NED) en France chez l’enfant (étude prélimlnaire)

Introduction et but de l’etude Les taux d’incidence et de prevalence de la NED chez l’enfant ( Materiel et methodes Selon la methode utilisee precedemment et grâce aux codes de la liste des produits et Prestations (LPP), Il a ete demande aux Directions Regionales du Service Medical de l’assurance maladie (DRSM) de l’ensemble du territoire de communiquer le nombre de patients pris en charge en NED en 2012, et de croiser ces resultats avec les fichiers d’Affection de Longue duree (ALD). Les patients ont ensuite ete regroupes en 7 categories (Cancerologie, Neurologie, Insuffisance d’Organe, MICI, Maladies Metaboliques, Autres, et Hors ALD) et en 3 tranches d’âge (0 a 4 ans, 5 a 9 ans, 10 a 15 ans). Resultats et Analyse statistique 7 DRSM ont repondu (Auvergne, Bretagne, Bourgogne-Franche-Comte, Limousin, Nord-pas de calais-Picardie, Poitou-Charentes, Reunion) correspondant a 9 regions et a 2,6 millions d’enfants. Les resultats sont donnes en pourcentage du nombre total de prise en charge (ALD+ hors ALD). Cancer % Neuro % MICI Insuf Organe Maladie Metab % Autres Hors ALD % 0 a 4 ans 3,4 21,3 0,1 24,3 15,5 2 33,4 5 a 9 ans 5,9 45,4 1,5 17,9 11,6 7,4 10,3 10 a 14 ans 7,3 47 12 14 8,9 5,7 5,1 Total 5,2 35,5 3,6 19,5 12,6 4,7 18,7 Conclusion Les indications de NED sont dominees par les affections neurologiques sur les tranches d’âge 5–15 ans. Les affections digestives repondant a l’ALD sont limitees aux maladies inflammatoires chroniques intestinales (MICI) et ne prennent pas en compte les sequelles de grele court et autres malformations congenitales digestives classees hors ALD representant 33,4 % des indications entre 0–4 ans. 18,7 % des patients sont declares hors ALD. Par contre, les enfants, a la difference des resultats chez l’adulte, ne cumulent pas plusieurs ALD.

PP108-SUN IMMUNONUTRITION LIMITS PRO-INFLAMMATORY AND PRO-OXIDANT RESPONSE TO RADIOCHEMOTHERAPY IN CANCER PATIENTS

and 17.4% in haematological patients. Length of stay was longer in haematology ward [29 (5 23) days vs 16 (5 25)]. Malnutrition worsens with longer hospital stay: 62% in patients admitted less than 10 days and 76.4% in those with longer hospitalisation. On the haematology ward, malnutrition on those patients admitted more than 10 days increased until 84.6%. Only 21.7% of all malnourished patients were referred to the clinical nutrition unit for nutritional support. There were 34.8% of errors in the diet given to the patients mainly because the prescribed diet was mistaken (28.3%). Conclusions: There are no differences between oncological and haematological inpatients comparing their nutritional status. However malnutrition increased with longer hospital stay. There is still a lack of awareness on the importance of nutritional support in patients with cancer. It’s important to conduct training sessions on the wards for proper indication of the diets.