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.
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.
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.
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.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Are the protein requirements of patients with hematological malignancies undergoing hematopoietic cell transplant different than the RDA?
Cheney C, Lenssen P, Aker S, Cunningham B, Gauvreau J, Darbinian J, Barale K. Sex differences in nitrogen balance following marrow grafting for leukemia. J Am Coll Nutr. 1987; 6(3): 223-230.
Geibig CB, Owens JP, Mirtallo JM;Bowers D, Nahikian-Nelms M, Tutschka P. Parenteral nutrition for marrow transplant recipients:evaluation of an increased nitrogen dose. Journal of Parenteral and Enteral Nutrition.1991:15(2):184-188.
Szeluga DJ, Stuart RK, Brookmeyer R, Utermohlen V, Santos GW. Energy requirements of parenterally fed bone marrow transplant recipients. J Parenter Enteral Nutr. 1985 Mar-Apr; 9(2): 139-143.