Glutamine-enriched parenteral nutrition after autologous peripheral blood stem cell transplantation: effects on immune reconstitution and mucositis.

Abstract

BACKGROUND AND OBJECTIVES:

Glutamine (gln), a non-essential amino acid, has recently received increasing attention because it becomes essential during stress and catabolic states: glutamine seems to modulate immune function and to promote faster intestinal healing after chemotherapy. We designed two consecutive randomized clinical trials to evaluate the role of glutamine-enriched parenteral nutrition (GEPN) in patients with hematologic malignancies submitted to high dose chemotherapy and autologous peripheral blood stem cell transplantation (aPBSCT) or immunoselected CD34+ aPBSCT.

DESIGN AND METHODS:

In study1, the Gln group (12 patients) received total parenteral nutrition (TPN) enriched with glutamine 20 g from day +1 after aPBSCT, while the placebo group (15 patients) received TPN lacking in glutamine (placebo). In study2, the Gln group (10 patients) received TPN enriched with glutamine 13.46 g from day +1, while the placebo group (11 patients) received a placebo.

RESULTS:

In the first study, a lymphocyte count >0.5 109/L was achieved on day 16.5 in the Gln group and on day 29 in the placebo group (p=0.005); in the second study, the lymphocyte count >0.5 109/L was achieved on day 18 in the Gln group and on day 29 in the placebo group (p=0.009). Lymphocyte subset analysis showed an increase of CD3+ and CD4+ and normalization of the CD16+CD56+ subset. Furthermore patients receiving GEPN showed a decrease in the mucositis severity peak calculated by the DMS (daily mucositis score: sum of the daily score of signs and symptoms) (p=0.047).

INTERPRETATION AND CONCLUSIONS:

GEPN is safe and effective and improves lymphocyte recovery after aPBSCT; further studies are needed to assess the clinical benefits of such an approach in order to justify its economic impact.

• Authors: Nicola Piccirillo, Silvia De Matteis, Luca Laurenti, Patrizia Chiusolo, Federica Sorà, Mauro Pittiruti, Sergio Rutella, Silvia Cicconi, Alessia Fiorini, Giuseppe D'Onofrio, Giuseppe Leone, Simona Sica
• Journal: Haematologica (Haematologica) Vol. 88 Issue 2 Pg. 192-200 (Feb 2003) ISSN: 0390-6078 [Print] Italy
• PMID: 12604409 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Glutamine

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Female
• Glutamine (administration & dosage, pharmacology)
• Hematologic Neoplasms (therapy)
• Humans
• Immune System (cytology, drug effects, growth & development)
• Lymphocyte Count
• Lymphocyte Subsets (cytology)
• Male
• Middle Aged
• Mouth Mucosa
• Parenteral Nutrition
• Peripheral Blood Stem Cell Transplantation (methods)
• Stomatitis (prevention & control)
• Transplantation, Autologous