Feasibility of prebiotic fibre supplementation during allogeneic stem cell transplantation

This trial evaluates feasibility of oral plus enteral prebiotic fibre supplementation during allogeneic stem cell transplantation (SCT) and the impact on clinical outcomes, the microbiome and immune function. The trial will take place on the haematology unit at the Royal Brisbane and Women's Hospital. The trial compares oral and enteral supplementation (group 1) to standard care (group 2). Group 1: Oral and enteral prebiotic supplement The intervention group will commence an oral prebiotic fibre supplement from a week prior to the start of conditioning therapy and continue it until a month post SCT. The prebiotic is a powdered fibre supplement mix of inulin, resistant starch and psyllium, split into two doses. Two sachets per day will provide a combined dose of 22g fibre per day. Participants will be advised to take the supplement with a meal and to commence 1 sachet per day for the first 3 days then increase to 2 sachets per day. The intervention group will commence fibre containing EN on day one post SCT and increase the feeding rate as per usual care. Participants will receive a polymeric ready to hang formula containing inulin, oligofructose, arabic gum, soy polysaccharides, cellulose and resistant starch providing 10-28g fibre per day (depending on the feeding rate required). Participants receiving partial prebiotic EN (at 30ml/hr or 50ml/hr) to meet part of their nutritional requirements will be encouraged to continue 1 prebiotic fibre oral sachet per day. Participants receving full rate prebiotic EN (>50ml/hr) to meet full estimated nutritional requirements (due to consuming minimal or nil oral intake) can cease the oral prebiotic supplement, Once EN reduces to meet partial requirements the oral prebiotic supplement will recommence at 1 sachet per day. Once EN ceases participants will be encouraged to take 2 sachets per day until study cessation. Adherence to prebiotic fibre supplementation will be measured by participants reporting the number of prebiotic fibre sachets consumed weekly. Additionally during provision of prebiotic enteral nutrition the amount provided will be collected from fluid balance charts. Group 2: Standard care. This group will receive standard fibre free enteral nutrition from day one after transplant as per usual care. The feeding commencement time, rate and cessation will be as per usual care ( the same as group 1.)