Altered Taste After Stem Cell Transplants for Multiple Myeloma May Negatively Affect Daily Calorie Intake, Quality of Life

Stem cell transplants may cause dysgeusia — a disorder that alters a person’s taste —in some patients with multiple myeloma, which is a type of blood cancer. This disorder may have a domino effect on quality of life, although levels may return to normal a few months after the procedure, an expert said.

Patients with multiple myeloma may experience taste changes after undergoing autologous hematopoietic cell transplantation, which may be associated with lower food consumption and higher levels of chemotherapy in the body, according to recent study findings.

“At the very least, we hoped that our study could more objectively quantify and describe what patients tell us in our daily practices all of the time,” said Dr. Michael Scordo, an assistant attending in the Adult Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center in New York, in an interview with CURE®. “I can tell you that when I discuss some of the findings with my patients undergoing autologous (hematopoietic cell transplantation) for (multiple myeloma), they are highly interested and pleased to hear that efforts are being made to study these all-too-common symptoms.”

Scordo added that although this is a common symptom of autologous hematopoietic cell transplantation, it is not one that is studied often by researchers.

Of note, an autologous hematopoietic cell transplantation is a procedure in which healthy stem cells are collected from a patient’s blood or bone marrow. Then, according to the National Cancer Institute, the healthy stem cells are stored while the patient receives chemotherapy and/or radiation. After treatment has been completed, the healthy stem cells are transplanted back into the patient to replace any cells that were damaged as a result of treatment.

“Taste disturbance — or dysgeusia — during and after cancer therapy is often reported by patients and can negatively affect nutritional intake and quality of life,” Scordo explained. “Dysgeusia frequently occurs in patients undergoing hematopoietic cell transplantation, wherein taste disturbances occur due to many factors including severe conditioning regimen-related oral-gastrointestinal mucosal injury, various medications and potentially changes in oral-(gastrointestinal) microbiome biodiversity.”

To assess taste disturbance, Scordo and colleagues used chemical gustometry to measure this symptom and its association with nutrition, symptom burden, the oral microbiome (viruses and microorganisms that live in the mouth) and chemotherapy pharmacokinetics (how drugs act in the body over time).

“We aimed to use a standardized method of taste testing called chemical gustometry to comprehensively assess taste disturbances in the five flavors (sweet, sour, salty, bitter, umami) over time in patients with multiple myeloma receiving high-dose melphalan prior to autologous (hematopoietic cell transplantation),” Scordo told CURE®. “We also explored some potential novel contributors to dysgeusia using blood and saliva samples, assessing whether higher blood and saliva melphalan pharmacokinetic exposure, and whether a reduction in oral microbiota diversity may influence taste after (hematopoietic cell transplantation).”

Researchers analyzed chemical gustometry scores of 45 patients in this study, of whom 87% completed at least four assessments and 49% completed all six assessments. Median total scores from the chemical gustometry assessments were stable over time but were the lowest at day seven (indicating taste disturbance) after undergoing autologous hematopoietic cell transplantation and returned to normal by day 100 after the transplant.

“While total chemical gustometry scores generally remained relatively stable over time early after (hematopoietic cell transplantation), some patients experienced abnormal chemical gustometry scores for specific taste solutions over time,” Scordo said. “For example, almost half of umami scores were abnormal at day (seven after transplant) and persisted in some patients until day 30 (after transplant), and about one-third of patients had altered salty scores at day 100 (after transplant).”

Approximately 10 days after undergoing autologous hematopoietic cell transplantation, patients faced the highest symptom burden, which was linked to the lowest median overall caloric intake at an average of 1,624 calories.

“We believe that specific taste disturbances may contribute to specific food aversions and changes in food preferences that may negative affect total nutritional intake,” Scordo explained.

Higher levels of melphalan in patients’ blood and saliva were associated with higher patient-reported taste disturbances and lower caloric intake.

Diversity of oral microbiota was stable early after patients underwent autologous hematopoietic cell transplantation and increased slightly by 100 days after the transplant.

Scordo said that the research he and his colleagues conducted may also apply to patients with other disease states.

“We … hope that the knowledge acquired through our current study can be applied to patients undergoing (hematopoietic cell transplantation) for other disorders or for patients receiving chemotherapy for other cancers,” he mentioned.

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