血液肿瘤治疗中的胃肠道毒性。对营养状况的影响

A narrative review was conducted using a literature search of the electronic databases PubMed, Embase, UpToDate, and Medscape for chemotherapy, targeted therapies, and immunotherapy used in lymphomas, leukemias, and multiple myeloma. The frequencies of gastrointestinal adverse effects (diarrhea, nausea/vomiting, mucositis), as well as those of grade ≥3, were analyzed.

The results are presented in tables showing the commonly used drugs along with the probability of experiencing gastrointestinal adverse effects. In acute lymphoblastic leukemia, therapies such as Tisa-Cel and Brexu-Cel, with or without cytotoxic agents, cause gastrointestinal toxicity in almost all patients. In acute myeloid leukemia, most drugs produce nausea and vomiting, while diarrhea and mucositis are less frequent (30%). In chronic lymphocytic leukemia, diarrhea is prominent with targeted therapies (ibrutinib [42%], idelalisib [47%]). In chronic myeloid leukemia, bosutinib causes the highest rate of gastrointestinal intolerance (68%). In non-Hodgkin lymphoma, most combinations induce nausea/vomiting (>90%). Regarding multiple myeloma, gastrointestinal effects are generally low, with the exception of some immunotherapies (selinexor, elranatamab, elotuzumab). DISCUSSION: Diarrhea, nausea, vomiting, and mucositis are common complications, with diverse mechanisms depending on the drug. These toxicities directly impact nutritional status and quality of life, potentially requiring modifications to treatments.

Understanding the frequency and severity of gastrointestinal side effects of drugs used to treat hematological malignancies can facilitate early diagnosis and medical-nutritional management, which can be key to reducing malnutrition and improving clinical outcomes in hematological tumors.