Nutritional care before hematopoietic stem cell transplantation in a patient with Philadelphia-positive acute lymphoblastic leukemia and gastric bypass: A case report.

OBJECTIVES

The presence of the Philadelphia chromosome (Ph⁺) in patients with acute lymphoblastic leukemia (ALL) is associated with a poor prognosis, characterized by reduced response to chemotherapy, shorter remissions, and lower overall survival rates. Malnutrition and obesity are risk factors for post-transplant complications and increased mortality in patients undergoing hematopoietic stem cell transplantation (HSCT), regardless of relapse status. However, the impact of prior bariatric surgery on HSCT outcomes remains unclear. This report describes the pre-HSCT nutritional management of a patient with Ph⁺ ALL who previously underwent bariatric surgery.

CASE DESCRIPTION: A 49-y-old female patient, initially well-nourished and lactovegetarian, was diagnosed with Ph⁺ ALL. She had previously undergone gastric bypass surgery (Roux-en-Y) and was eligible for allogeneic HSCT. During remission induction therapy, she developed adverse effects that led to deterioration of her nutritional status, as assessed by the Patient-Generated Subjective Global Assessment, arm and calf circumferences, and handgrip strength.

RESULTS

Oral and enteral nutritional therapy during induction treatment resulted in improvements in body weight, arm and calf circumferences, body composition estimated from bioelectrical impedance analysis, and muscle strength.

CONCLUSIONS

Adequate nutritional care improved the patient's nutritional status and may have contributed to better clinical outcomes. The lack of available studies emphasizes the need for further research to better understand how prior gastric bypass surgery may affect nutrition and clinical outcomes after HSCT.