Skip to main content

Advertisement

SpringerLink
Log in

Geriatric nutritional risk index as a useful prognostic factor in second allogeneic hematopoietic stem cell transplantation

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Second allogeneic hematopoietic stem cell transplantation (allo-HSCT) has a low survival outcome and a high non-relapse mortality (NRM) rate which is a major obstacle to this treatment. We hypothesized that the status of malnourishment after first allo-HSCT as represented by the geriatric nutritional risk index (GNRI) could be used as a prognostic factor to determine the outcomes of second allo-HSCT. A total of 108 patients with a median age of 42 (range, 17–69) years, who received second allo-HSCT for disease recurrence after first allo-HSCT from our institution, were included in this study. Low GNRI had a significant impact on NRM at 2 years after second allo-HSCT: 56.9% in patients with GNRI ≤ 92 compared with 27.5% in patients with GNRI > 92 (P = 0.002). In multivariate analysis, GNRI of ≤ 92 was the only significant factor for NRM (hazard ratio [HR] 2.29, 95% confidence interval [CI] 1.15–4.56, P = 0.018). High-risk disease status at second allo-HSCT (HR 2.74, 95% CI 1.46–5.14, P = 0.002) and GNRI of ≤ 92 (HR 1.70, 95% CI 1.02–2.82, P = 0.042) were identified as significant factors for overall survival (OS). A score of 1 was assigned to each factor, and the OS rate at 2 years after second allo-HSCT decreased according to the score: 53.0% in patients with score 0, 32.3% with score 1, and 2.5% with score 2 (P < 0.001). In conclusion, GNRI could be a useful predictor for the outcomes of second allo-HSCT. A prospective study in other cohorts is warranted to validate the findings of our study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pavletic SZ, Kumar S, Mohty M, de Lima M, Foran JM, Pasquini M, Zhang MJ, Giralt S, Bishop MR, Weisdorf D (2010) NCI first international workshop on the biology, prevention, and treatment of relapse after allogeneic hematopoietic stem cell transplantation: report from the committee on the epidemiology and natural history of relapse following allogeneic cell transplantation. Biol Blood Marrow Transplant 16:871–890

    Article  PubMed  PubMed Central  Google Scholar 

  2. Porter DL, Alyea EP, Antin JH, DeLima M, Estey E, Falkenburg JH et al (2010) NCI first international workshop on the biology, prevention, and treatment of relapse after allogeneic hematopoietic stem cell transplantation: report from the committee on treatment of relapse after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 16:1467–1503

    Article  PubMed  PubMed Central  Google Scholar 

  3. Warlick ED, Cioc A, Defor T, Dolan M, Weisdorf D (2009) Allogeneic stem cell transplantation for adults with myelodysplastic syndromes: importance of pretransplant disease burden. Biol Blood Marrow Transplant 15:30–38

    Article  PubMed  Google Scholar 

  4. Armistead PM, de Lima M, Pierce S, Qiao W, Wang X, Thall PF, Giralt S, Ravandi F, Kantarjian H, Champlin R, Estey E (2009) Quantifying the survival benefit for allogeneic hematopoietic stem cell transplantation in relapsed acute myelogenous leukemia. Biol Blood Marrow Transplant 15:1431–1438

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thanarajasingam G, Kim HT, Cutler C, Ho VT, Koreth J, Alyea EP, Antin JH, Soiffer RJ, Armand P (2013) Outcome and prognostic factors for patients who relapse after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 19:1713–1718

    Article  PubMed  Google Scholar 

  6. Kishi K, Takahashi S, Gondo H, Shiobara S, Kanamaru A, Kato S, Hirabayashi N, Moriyama Y, Harada M, Asano S, Hara H, Shibata A (1997) Second allogeneic bone marrow transplantation for post-transplant leukemia relapse: results of a survey of 66 cases in 24 Japanese institutes. Bone Marrow Transplant 19:461–466

    Article  CAS  PubMed  Google Scholar 

  7. Michallet M, Tanguy ML, Socie G, Thiebaut A, Belhabri A, Milpied N, et al (2000) Second allogeneic haematopoietic stem cell transplantation in relapsed acute and chronic leukaemias for patients who underwent a first allogeneic bone marrow transplantation: a survey of the Societe Francaise de Greffe de Moelle (SFGM) Br J Haematol 108:400–407

  8. Bosi A, Laszlo D, Labopin M, Reffeirs J, Michallet M, Gluckman E, Alessandrino PE, Locatelli F, Vernant JP, Sierra J, Jouet JP, Frassoni F, for the Acute Leukemia Working Party of the European Blood and Marrow Transplant Group (2001) Second allogeneic bone marrow transplantation in acute leukemia: results of a survey by the European cooperative group for blood and marrow transplantation. J Clin Oncol 19:3675–3684

    Article  CAS  PubMed  Google Scholar 

  9. Eapen M, Giralt SA, Horowitz MM, Klein JP, Wagner JE, Zhang MJ, Tallman MS, Marks DI, Camitta BM, Champlin RE, Ringdén O, Bredeson CN, Martino R, Gale RP, Cairo MS, Litzow MR, deLima M (2004) Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant. Bone Marrow Transplant 34:721–727

    Article  CAS  PubMed  Google Scholar 

  10. Shaw BE, Mufti GJ, Mackinnon S, Cavenagh JD, Pearce RM, Towlson KE, Apperley JF, Chakraverty R, Craddock CF, Kazmi MA, Littlewood TJ, Milligan DW, Pagliuca A, Thomson KJ, Marks DI, Russell NH (2008) Outcome of second allogeneic transplants using reduced-intensity conditioning following relapse of haematological malignancy after an initial allogeneic transplant. Bone Marrow Transplant 42:783–789

    Article  CAS  PubMed  Google Scholar 

  11. Kedmi M, Resnick IB, Dray L, Aker M, Samuel S, Gesundheit B, Slavin S, Or R, Shapira MY (2009) A retrospective review of the outcome after second or subsequent allogeneic transplantation. Biol Blood Marrow Transplant 15:483–489

    Article  CAS  PubMed  Google Scholar 

  12. Christopeit M, Kuss O, Finke J, Bacher U, Beelen DW, Bornhauser M et al (2013) Second allograft for hematologic relapse of acute leukemia after first allogeneic stem-cell transplantation from related and unrelated donors: the role of donor change. J Clin Oncol 31:3259–3271

    Article  PubMed  Google Scholar 

  13. Ruutu T, de Wreede LC, van Biezen A, Brand R, Mohty M, Dreger P et al (2015) Second allogeneic transplantation for relapse of malignant disease: retrospective analysis of outcome and predictive factors by the EBMT. Bone Marrow Transplant 50:1542–1550

    Article  CAS  PubMed  Google Scholar 

  14. Andreola G, Labopin M, Beelen D, Chevallier P, Tabrizi R, Bosi A, Michallet M, Santarone S, Ehninger G, Polge E, Laszlo D, Schmid C, Nagler A, Mohty M (2015) Long-term outcome and prognostic factors of second allogeneic hematopoietic stem cell transplant for acute leukemia in patients with a median follow-up of 10 years. Bone Marrow Transplant 50:1508–1512

    Article  CAS  PubMed  Google Scholar 

  15. Orti G, Sanz J, Bermudez A, Caballero D, Martinez C, Sierra J, Cabrera Marin JR, Espigado I, Solano C, Ferrà C, García-Noblejas A, Jimenez S, Sampol A, Yañez L, García-Gutiérrez V, Pascual MJ, Jurado M, Moraleda JM, Valcarcel D, Sanz MA, Carreras E, Duarte RF (2016) Outcome of second allogeneic hematopoietic cell transplantation after relapse of myeloid malignancies following allogeneic hematopoietic cell transplantation: a retrospective cohort on behalf of the Grupo Espanol de Trasplante Hematopoyetico. Biol Blood Marrow Transplant 22:584–588

    Article  PubMed  Google Scholar 

  16. Kharfan-Dabaja MA, Labopin M, Polge E, Nishihori T, Bazarbachi A, Finke J, Stadler M, Ehninger G, Lioure B, Schaap N, Afanasyev B, Yeshurun M, Isaksson C, Maertens J, Chalandon Y, Schmid C, Nagler A, Mohty M (2018) Association of second allogeneic hematopoietic cell transplant vs donor lymphocyte infusion with overall survival in patients with acute myeloid leukemia relapse. JAMA Oncol 4:1245–1253

    Article  PubMed  Google Scholar 

  17. El-Ghammaz AMS, Ben Matoug R, Elzimaity M, Mostafa N (2017) Nutritional status of allogeneic hematopoietic stem cell transplantation recipients: influencing risk factors and impact on survival. Support Care Cancer 25:3085–3093

    Article  PubMed  Google Scholar 

  18. Brotelle T, Lemal R, Cabrespine A, Combal C, Hermet E, Ravinet A, Bay JO, Bouteloup C (2018) Prevalence of malnutrition in adult patients previously treated with allogeneic hematopoietic stem-cell transplantation. Clin Nutr 37:739–745

    Article  PubMed  Google Scholar 

  19. Chandra RK (1997) Nutrition and the immune system: an introduction. Am J Clin Nutr 66:460s–463s

    Article  CAS  PubMed  Google Scholar 

  20. Bourke CD, Berkley JA, Prendergast AJ (2016) Immune dysfunction as a cause and consequence of malnutrition. Trends Immunol 37:386–398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kaito S, Sekiya N, Najima Y, Suzuki T, Wada A, Adachi H, Konuma R, Kishida Y, Nagata A, Konishi T, Yamada Y, Kumagai T, Inamoto K, Yoshifuji K, Akiyama M, Toya T, Igarashi A, Muto H, Doki N, Kobayashi T, Kakihana K, Ohashi K (2020) Nutritional risk index as a risk factor for breakthrough candidemia in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 55:661–664

    Article  PubMed  Google Scholar 

  22. Buzby GP, Knox LS, Crosby LO, Eisenberg JM, Haakenson CM, McNeal GE et al (1988) Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients. Am J Clin Nutr 47:366–381

    Article  CAS  PubMed  Google Scholar 

  23. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C (2005) Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82:777–783

    Article  CAS  PubMed  Google Scholar 

  24. Kanemasa Y, Shimoyama T, Sasaki Y, Hishima T, Omuro Y (2018) Geriatric nutritional risk index as a prognostic factor in patients with diffuse large B cell lymphoma. Ann Hematol 97:999–1007

    Article  PubMed  Google Scholar 

  25. Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, Kumagai H (2008) Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 87:106–113

    Article  CAS  PubMed  Google Scholar 

  26. Kinugasa Y, Kato M, Sugihara S, Hirai M, Yamada K, Yanagihara K, Yamamoto K (2013) Geriatric nutritional risk index predicts functional dependency and mortality in patients with heart failure with preserved ejection fraction. Circ J 77:705–711

    Article  CAS  PubMed  Google Scholar 

  27. Gu W, Zhang G, Sun L, Ma Q, Cheng Y, Zhang H, Shi G, Zhu Y, Ye D (2015) Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle 6:222–230

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bo Y, Wang K, Liu Y, You J, Cui H, Zhu Y, Lu Q, Yuan L (2016) The geriatric nutritional risk index predicts survival in elderly esophageal squamous cell carcinoma patients with radiotherapy. PLoS One 11:e0155903

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Miyake H, Tei H, Fujisawa M (2017) Geriatric nutrition risk index is an important predictor of cancer-specific survival, but not recurrence-free survival, in patients undergoing surgical resection for non-metastatic renal cell carcinoma. Curr Urol 10:26–31

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shoji F, Miura N, Matsubara T, Akamine T, Kozuma Y, Haratake N, Takamori S, Katsura M, Takada K, Toyokawa G, Takenaka T, Yamazaki K, Okamoto T, Takeo S, Maehara Y (2018) Prognostic significance of immune-nutritional parameters for surgically resected elderly lung cancer patients: a multicentre retrospective study. Interact Cardiovasc Thorac Surg 26:389–394

    Article  PubMed  Google Scholar 

  31. Li L, Wang H, Yang J, Jiang L, Yang J, Wu H, Wen T, Yan L (2018) Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma. Sci Rep 8:12561

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Yoshihisa A, Kanno Y, Watanabe S, Yokokawa T, Abe S, Miyata M, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Nakazato K, Suzuki H, Ishida T, Takeishi Y (2018) Impact of nutritional indices on mortality in patients with heart failure. Open Heart 5:e000730

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sasaki H, Nagano S, Komiya S, Taniguchi N, Setoguchi T (2018) Validation of different nutritional assessment tools in predicting prognosis of patients with soft tissue spindle-cell sarcomas. Nutrients 10:765

    Article  PubMed Central  CAS  Google Scholar 

  34. Konishi T, Doki N, Kishida Y, Nagata A, Yamada Y, Kaito S, Kurosawa S, Yoshifuji K, Shirane S, Uchida T, Inamoto K, Toya T, Igarashi A, Najima Y, Kobayashi T, Kakihana K, Sakamaki H, Ohashi K (2019) Geriatric nutritional risk index (GNRI) just before allogeneic hematopoietic stem cell transplantation predicts transplant outcomes in patients older than 50 years with acute myeloid leukemia in complete remission. Ann Hematol 98:1799–1801

    Article  PubMed  Google Scholar 

  35. Okada M, Tasaka T, Ikegame K, Aotsuka N, Kobayashi T, Najima Y, Matsuhashi Y, Wada H, Tokunaga H, Masuda S, Utsu Y, Yoshihara S, Kaida K, Daimon T, Ogawa H (2018) A prospective multicenter phase II study of intrabone marrow transplantation of unwashed cord blood using reduced-intensity conditioning. Eur J Haematol 100:335–343

    Article  CAS  PubMed  Google Scholar 

  36. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B (2005) Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106:2912–2919

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Nakasone H, Fukuda T, Kanda J, Mori T, Yano S, Kobayashi T et al (2015) Impact of conditioning intensity and TBI on acute GVHD after hematopoietic cell transplantation. Bone Marrow Transplant 50:559–565

    Article  CAS  PubMed  Google Scholar 

  38. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, Thomas ED (1995) 1994 Consensus conference on acute GVHD grading. Bone Marrow Transplant 15:825–828

    CAS  PubMed  Google Scholar 

  39. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al (1980) Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 69:204–217

    Article  CAS  PubMed  Google Scholar 

  40. Ikegame K, Yoshida T, Yoshihara S, Daimon T, Shimizu H, Maeda Y, Ueda Y, Kaida K, Ishii S, Taniguchi K, Okada M, Tamaki H, Okumura H, Kaya H, Kurokawa T, Kodera Y, Taniguchi S, Kanda Y, Ogawa H (2015) Unmanipulated haploidentical reduced-intensity stem cell transplantation using fludarabine, busulfan, low-dose antithymocyte globulin, and steroids for patients in non-complete remission or at high risk of relapse: a prospective multicenter phase I/II study in Japan. Biol Blood Marrow Transplant 21:1495–1505

    Article  CAS  PubMed  Google Scholar 

  41. Giralt S, Ballen K, Rizzo D, Bacigalupo A, Horowitz M, Pasquini M, Sandmaier B (2009) Reduced-intensity conditioning regimen workshop: defining the dose spectrum. Report of a workshop convened by the center for international blood and marrow transplant research. Biol Blood Marrow Transplant 15:367–369

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  43. Artz AS, Logan B, Zhu X, Akpek G, Bufarull RM, Gupta V et al (2016) The prognostic value of serum C-reactive protein, ferritin, and albumin prior to allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes. Haematologica 2101:1426–1433

    Article  CAS  Google Scholar 

  44. Fuji S, Takano K, Mori T, Eto T, Taniguchi S, Ohashi K, Sakamaki H, Morishima Y, Kato K, Miyamura K, Suzuki R, Fukuda T (2014) Impact of pretransplant body mass index on the clinical outcome after allogeneic hematopoietic SCT. Bone Marrow Transplant 49:1505–1512

    Article  CAS  PubMed  Google Scholar 

  45. Doney K, McMillen K, Buono L, Deeg HJ, Gooley T (2019) Impact of body mass index on outcomes of hematopoietic stem cell transplantation in adults. Biol Blood Marrow Transplant 25:613–620

    Article  PubMed  Google Scholar 

  46. Guieze R, Lemal R, Cabrespine A, Hermet E, Tournilhac O, Combal C et al (2014) Enteral versus parenteral nutritional support in allogeneic haematopoietic stem-cell transplantation. Clin Nutr 33:533–538

    Article  PubMed  Google Scholar 

  47. Seguy D, Duhamel A, Rejeb MB, Gomez E, Buhl ND, Bruno B, Cortot A, Yakoub-Agha I (2012) Better outcome of patients undergoing enteral tube feeding after myeloablative conditioning for allogeneic stem cell transplantation. Transplantation 94:287–294

    Article  CAS  PubMed  Google Scholar 

  48. Baumgartner A, Bargetzi A, Zueger N, Bargetzi M, Medinger M, Bounoure L, Gomes F, Stanga Z, Mueller B, Schuetz P (2017) Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review. Bone Marrow Transplant 52:506–513

    Article  CAS  PubMed  Google Scholar 

  49. Tischer J, Engel N, Fritsch S, Prevalsek D, Hubmann M, Schulz C, Zoellner AK, Bücklein V, Lippl S, Reibke R, Rieger CT, Ledderose G, Stemmler HJ, Hiddemann W, Schmid C, Hausmann A (2014) Second haematopoietic SCT using HLA-haploidentical donors in patients with relapse of acute leukaemia after a first allogeneic transplantation. Bone Marrow Transplant 49:895–901

    Article  CAS  PubMed  Google Scholar 

  50. Yeh SP, Lin CC, Lin CH, Lo WC, Chen TT, Lo WJ, Lin CL, Chiu CF (2015) Second haploidentical peripheral blood stem cell transplantation for treatment of acute leukemia with relapse after first allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 50:1001–1003

    Article  CAS  PubMed  Google Scholar 

  51. Konuma T, Kato S, Ooi J, Ebihara Y, Mochizuki S, Ishii H, Takei T, Oiwa-Monna M, Tojo A, Takahashi S (2016) Second allogeneic transplantation using unrelated cord blood for relapsed hematological malignancies after allogeneic transplantation. Leuk Lymphoma 57:103–109

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the nursing staff at Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, for their excellent patient care.

Author information

Authors and Affiliations

  1. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Satoshi Kaito, Atsushi Wada, Hiroto Adachi, Ryosuke Konuma, Yuya Kishida, Akihito Nagata, Tatsuya Konishi, Yuta Yamada, Takuma Kumagai, Kota Yoshifuji, Junichi Mukae, Megumi Akiyama, Kyoko Inamoto, Takashi Toya, Aiko Igarashi, Yuho Najima, Hideharu Muto, Takeshi Kobayashi, Kazuhiko Kakihana, Kazuteru Ohashi, Hisashi Sakamaki & Noriko Doki

Authors
  1. Satoshi Kaito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroto Adachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryosuke Konuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuya Kishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akihito Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tatsuya Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuta Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takuma Kumagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kota Yoshifuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Junichi Mukae
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Megumi Akiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kyoko Inamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Takashi Toya
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Aiko Igarashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yuho Najima
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Hideharu Muto
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Takeshi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Kazuhiko Kakihana
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Kazuteru Ohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Hisashi Sakamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Noriko Doki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Noriko Doki.

Ethics declarations

This study was performed in accordance with the Declaration of Helsinki and approved by the ethics committee of Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital (permission number 2178).

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaito, S., Wada, A., Adachi, H. et al. Geriatric nutritional risk index as a useful prognostic factor in second allogeneic hematopoietic stem cell transplantation. Ann Hematol 99, 1655–1665 (2020). https://doi.org/10.1007/s00277-020-04089-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-020-04089-0

Keywords

Search

Navigation