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Glutamine-enriched parenteral nutrition after autologous peripheral blood stem cell transplantation: effects on immune reconstitution and mucositis.
Haematologica 2003; 88(2):192-200H

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+Show Affiliations

Hematology Institute, Università Cattolica del Sarco Cuore, Rome, Italy. emacat@rm.unicatt.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12604409

Citation

Piccirillo, Nicola, et al. "Glutamine-enriched Parenteral Nutrition After Autologous Peripheral Blood Stem Cell Transplantation: Effects On Immune Reconstitution and Mucositis." Haematologica, vol. 88, no. 2, 2003, pp. 192-200.
Piccirillo N, De Matteis S, Laurenti L, et al. Glutamine-enriched parenteral nutrition after autologous peripheral blood stem cell transplantation: effects on immune reconstitution and mucositis. Haematologica. 2003;88(2):192-200.
Piccirillo, N., De Matteis, S., Laurenti, L., Chiusolo, P., Sorà, F., Pittiruti, M., ... Sica, S. (2003). Glutamine-enriched parenteral nutrition after autologous peripheral blood stem cell transplantation: effects on immune reconstitution and mucositis. Haematologica, 88(2), pp. 192-200.
Piccirillo N, et al. Glutamine-enriched Parenteral Nutrition After Autologous Peripheral Blood Stem Cell Transplantation: Effects On Immune Reconstitution and Mucositis. Haematologica. 2003;88(2):192-200. PubMed PMID: 12604409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glutamine-enriched parenteral nutrition after autologous peripheral blood stem cell transplantation: effects on immune reconstitution and mucositis. AU - Piccirillo,Nicola, AU - De Matteis,Silvia, AU - Laurenti,Luca, AU - Chiusolo,Patrizia, AU - Sorà,Federica, AU - Pittiruti,Mauro, AU - Rutella,Sergio, AU - Cicconi,Silvia, AU - Fiorini,Alessia, AU - D'Onofrio,Giuseppe, AU - Leone,Giuseppe, AU - Sica,Simona, PY - 2003/2/27/pubmed PY - 2003/6/11/medline PY - 2003/2/27/entrez SP - 192 EP - 200 JF - Haematologica JO - Haematologica VL - 88 IS - 2 N2 - 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. SN - 0390-6078 UR - https://www.unboundmedicine.com/medline/citation/12604409/Glutamine_enriched_parenteral_nutrition_after_autologous_peripheral_blood_stem_cell_transplantation:_effects_on_immune_reconstitution_and_mucositis_ L2 - http://www.haematologica.org/cgi/pmidlookup?view=long&pmid=12604409 DB - PRIME DP - Unbound Medicine ER -