Phase Angle and Dry Weight Benefit Nutritional Management of a Patient with Primary Myelofibrosis Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Background: Progressive, involuntary weight loss (WL) is common in patients with primary myelofibrosis (PMF), and the etiology of this manifestation is multifactorial. A triad of ascites, edema, and splenomegaly is common; therefore, the body weight may be overestimated due to fluid overload. A comprehensive nutritional assessment, including measurement of dry weight, is necessary for monitoring disease progression and to allow the effective planning of nutritional interventions. Also, the phase angle (PA) has been suggested as an important prognostic and muscle mass marker in patients with cancer. To date, there have been no reports of bioimpedance analysis (BIA) of patients with PMF. Case Presentation: A 56-year-old man with PMF underwent allogeneic hematopoietic stem cell transplantation (HSCT) with fatigue and postprandial abdominal fullness, exhibiting splenomegaly (> 10 cm) and bilateral lower-extremity edema. On day –13, a BIA was performed. The patient had a body weight of 73.5 kg, with a fluid balance of +9.2 L and a PA at 50 kHz of 3.15°. A nutritional intervention was administered for 26 days, and on day +13 of HSCT, a repeat BIA revealed an estimated body weight of 69.7 kg with a fluid balance of +5.8 L and a PA at 50 kHz of 3.17°, as well as nonsignificant WL (3.1% in 1 month). Conclusions: This case report is an important addition to the nutritional assessment of PFM patients, since we could provide a better nutritional intervention due to our understanding of the estimated dry weight and assess the PA to investigate a new element of prognosis. Additional studies are needed to demonstrate the effectiveness of BIA in these patients.