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Recommendations Summary

ONC: Hematological Malignancies (HCT): Determination of Protein Needs 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    ONC: HCT: Determination of Protein Needs

    The protein needs for patients with hematologic malignancies undergoing allogeneic HCT are higher than the RDA. Limited evidence suggests that more than 2.2g protein per kg may be needed to maintain nitrogen balance. Further research is needed to define protein requirements in this population.

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      Use of high protein diets may be contraindicated in patients with hepatic or renal disease.

    • Conditions of Application

      This recommendation applies to adult patients receiving myeloablative allogeneic HCT. Protein needs may be different for patients receiving non-myeloablative and/or autologous HCT.

    • Potential Costs Associated with Application

      There are no obvious costs associated with the application of this recommendation.

    • Recommendation Narrative

      Three studies (one neutral quality time-series, one positive quality RCT, and one positive quality longitudinal study) assessed the protein requirements of patients undergoing HCT in order to maintain positive nitrogen balance in the post-transplant period.

      • Two of these studies (Cheney et al, 1987 and Szeluga et al, 1985) did not reach nitrogen balance with protein intakes of 1.2-1.7g protein per kg.
      • The one study that did reach nitrogen balance (Geibig et al, 1991) provided 2.2g protein per kg.

      Patients in the above mentioned studies received myeloablative HCT regimens. More recently non-myeloablative HCT has begun to replace myeloblative HCT. The protein needs of patients may be different with non-myeloablative HCT.
       

    • Recommendation Strength Rationale

      Based on three studies (one neutral-quality time-series, one positive quality RCT, and one positive quality longitudinal study), conclusion statement is a Grade II.