medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-9-156-164medsovet-5719Research ArticleПОДДЕРЖИВАЮЩАЯ ТЕРАПИЯ В ОНКОЛОГИИSUPPORTIVE THERAPY IN ONCOLOGYОсобенности нутриционной поддержки при проведении трансплантации гемопоэтических стволовых клетокFeatures of nutritional support during stem cell transplantationhttps://orcid.org/0000-0002-2463-2024ВолчёнковС. А.VolchenkovS. A.

Волчёнков Станислав Андреевич, аспирант, научный сотрудник отдела инновационных методов терапевтической онкологии и реабилитации, врач-онколог отделения гематологии и химиотерапии с палатой интенсивной терапии и реанимации

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68

Stanislav A. Volchenkov, Graduate Student, Researcher of the Department of Innovative Methods of Therapeutic Oncology and Rehabilitation, Medical Oncologist of the Department of Hematology and Chemotherapy with Intensive Care Unit

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758

Stanislav.volchenkov@yahoo.comhttps://orcid.org/0000-0002-0728-4582ФилатоваЛ. В.FilatovaL. V.

Филатова Лариса Валентиновна, д.м.н., ведущий научный сотрудник отдела инновационных методов терапевтической онкологии и реабилитации, врач-онколог отделения гематологии и химиотерапии с палатой интенсивной терапии и реанимации; профессор кафедры онкологии

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

191015, Санкт-Петербург, ул. Кирочная, д. 41

Larisa V. Filatova, Dr. of Sci. (Med), Academician of the Department of Innovative Methods of Therapeutic Oncology and Rehabilitation, Medical Oncologist of the Department of Hematology and Chemotherapy with Intensive Care Unit; Professor of the Department of Oncology

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758

41, Kirochnaya St., St Petersburg, 191015

larisa_filatova@list.ruhttps://orcid.org/0000-0002-8759-5136ЧеркасоваЕ. В.CherkasovaE. V.

Черкасова Евгения Викторовна, врач-онколог отделения гематологии и химиотерапии с палатой интенсивной терапии и реанимации

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

Evgeniia V. Cherkasova, Medical Oncologist of the Department of Hematology and Chemotherapy with Intensive Care Unit

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758

evgeniyacherkasova0612@yandex.ruКовязинА. К.KoviazinA. K.

Ковязин Алексей Константинович, аспирант, научный сотрудник отдела инновационных методов терапевтической онкологии и реабилитации

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

Aleksei K. Koviazin, Graduate Student, Researcher of Department of Innovative Methods of Therapeutic Oncology and Rehabilitation

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758

akkoviazin@gmail.comhttps://orcid.org/0000-0002-2514-9747ЛюбимовС. В.LyubimovS. V.

Любимов Станислав Вадимович, заведующий реанимационным блоком отделения гематологии и химиотерапии с палатой интенсивной терапии и реанимации

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

Stanislav V. Lyubimov, Chief of Intensive Care Unit of the Department of Hematology and Chemotherapy with Intensive Care Unit

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758

Stanislav.lyubimov.bmt@gmail.comЗюзгинИ. С.ZyuzginI. S.

Зюзгин Илья Сергеевич, к.м.н., заведующий отделением гематологии и химиотерапии с палатой интенсивной терапии и реанимации

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

Ilia S. Zyuzgin, Cand. of Sci. (Med.), Chief of the Department of Hematology and Chemotherapy with Intensive Care Unit

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758

https://orcid.org/0000-0002-4305-6691CемиглазоваТ. Ю.SemiglazovaT. Yu.

Семиглазова Татьяна Юрьевна, д.м.н., доцент, заведующая отделом – ведущий научный сотрудник научного отдела инновационных методов терапевтической онкологии и реабилитации; профессор кафедры онкологии

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

191015, Санкт-Петербург, ул. Кирочная, д. 41

Tatiana Yu. Semiglazova, Dr. of Sci. (Med), Assistant Professor, Academician and Chief of the Department of Innovative Methods of Therapeutic Oncology and Rehabilitation; Professor of the Department of Oncology

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758

41, Kirochnaya St., St Petersburg, 191015

tsemiglazova@mail.ruНациональный медицинский исследовательский центр онкологии им. Н.Н. ПетроваРоссияPetrov National Medical Cancer Research CentreRussian FederationНациональный медицинский исследовательский центр онкологии им. Н.Н. Петрова; Северо-Западный государственный медицинский университет им. И.И. МечниковаРоссияPetrov National Medical Cancer Research Centre; North-Western State Medical University named after I.I. MechnikovRussian Federation20202807202009156164Copyright © Волчёнков С.А., Филатова Л.В., Черкасова Е.В., Ковязин А.К., Любимов С.В., Зюзгин И.С., Cемиглазова Т.Ю., 20202020Волчёнков С.А., Филатова Л.В., Черкасова Е.В., Ковязин А.К., Любимов С.В., Зюзгин И.С., Cемиглазова Т.Ю.Volchenkov S.A., Filatova L.V., Cherkasova E.V., Koviazin A.K., Lyubimov S.V., Zyuzgin I.S., Semiglazova T.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5719

Представлен обзор литературы по особенностям нутриционной поддержки онкогематологических больных, перенесших аллогенную (аллоТГСК) и аутологичную трансплантации гемопоэтических стволовых клеток (аутоТГСК). Трансплантация костного мозга ассоциирована с высоким риском развития нутриционной недостаточности. Нутриционная поддержка (НП) показана больным, перенесшим аллоТГСК и аутоТГСК с целью снижения частоты развития инфекционных осложнений, снижения риска развития тяжелых форм острой и хронической реакции «трансплантат против хозяина» (РТПХ). В настоящее время есть рекомендации по проведению НП при аллоТГСК, в то время как нет рекомендаций для пациентов при аутоТГСК. Важной задачей при планировании НП является расчет суточной энергетической потребности. Трансплантация костного мозга сопровождается длительным отрицательным балансом азота. Потребность в белке при проведении аллоТГСК значительно выше, чем у пациентов при проведении химиотерапии, и составляет 1,5–2 г/кг в сутки. Эффективным методом мониторинга потребности в белке у гематологических пациентов при проведении аутоТГСК и аллоТГСК является расчет азотистого баланса и суточной нормы белка. Проанализирована роль макронутриентов и иммунонутриентов в восстановлении пациентов при проведении аллоТГСК. Показано, что низкий уровень витамина D, витамина А увеличивает риск развития и тяжесть течения реакции «трансплантат против хозяина». Добавление омега-3 жирных кислот способствует поддержанию оптимальной пропорции потребления калорий из липидов, а также поддержанию необходимого уровня триглицеридов в крови. В статье представлены данные о снижении риска развития острой РТПХ при системном добавлении омега-3 жирных кислот. Для окончательной оценки влияния нейтропенической диеты на развитие инфекционных осложнений у онкогематологических пациентов необходимы рандомизированные проспективные многоцентровые исследования с разработкой единого подхода к выбору диеты при проведении ТГСК.

This article presented a review of the literature on the features of nutritional support for oncohematological patients who have undergone allogeneic (alloHSCT)/autologous hematopoietic stem cell transplantation (autoHSCT). Bone marrow transplantation associated with a high risk of developing nutritional deficiencies. Nutritional support (NP) is indicated for patients undergoing alloHSCT and autoHSCT in order to reduce the incidence of infectious complications and reduce the risk of developing severe forms of acute and chronic GVHD. Currently, there are recommendations for conducting NP in alloHSCT, while there are no recommendations for patients with autoHSCT. An important task in planning NP is the calculation of the daily energy requirement. Bone marrow transplantation accompanied by a prolonged negative nitrogen balance. The protein requirement for alloHSCT is significantly higher than for patients with chemotherapy alone – 1.5–2 g/kg per day. An effective method of controlling the needs of hematological patients during the analysis of HSCT and alloHSCT is the calculation of the nitrogen balance and the daily protein norm. In this article was analyzed the role of macronutrients and immunonutrients in the recovery of patients during alloHSCT. It has been shown that low levels of vitamin D and vitamin A increase the risk of development and the severity of the transplant versus host reaction. The addition of omega-3 fatty acids helps maintain an optimal proportion of calorie intake from lipids, as well as maintain the necessary level of triglycerides in the blood. The article presents data on reducing the risk of developing acute GVHD with systemic addition of omega-3 fatty acids. For a final assessment of the effect of the neutropenic diet on the development of infectious complications in oncohematological patients, randomized prospective multicenter studies with the development of a unified approach in choosing a diet for HSCT are needed.

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The authors declare that there are no conflicts of interest present.