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WITHDRAWN: Nutrition support for bone marrow transplant patients.
Cochrane Database Syst Rev 2017; 3:CD002920CD

Abstract

BACKGROUND

This is an update of the original Cochrane review published in Issue 2, 2002. Bone marrow transplantation involves administration of toxic chemotherapy and infusion of marrow cells. After treatment, patients can develop poor appetite, mucositis and gastrointestinal failure, leading to malnutrition. To prevent this, parenteral nutrition (PN) support is often first choice but is associated with increased risk of infection. Enteral nutrition (EN) is an alternative, as is addition of substrates.

OBJECTIVES

To determine efficacy of EN or PN support for patients receiving bone marrow transplant.

SEARCH METHODS

Search of The Cochrane Library, MEDLINE, EMBASE and CINAHL in November 2000 and subsequently June 2006.

SELECTION CRITERIA

RCTs that compared one form of nutrition support with another, or control, for bone marrow transplant patients.

DATA COLLECTION AND ANALYSIS

Twenty nine studies were identified. Data were collected on participants' characteristics; adverse effects; neutropaenia; % change in body weight; graft versus host disease; and survival.

MAIN RESULTS

In two studies (82 participants) glutamine mouthwash reduced number of days patients were neutropenic (6.82 days, 95%CI (1.67 to 11.98) P = 0.009) compared with placebo. Three studies reported (103 participants) that patients receiving PN with glutamine had reduced hospital stay, 6.62 d (95%CI 3.47 to 9.77, P = 0.00004) compared with patients receiving standard PN. However, in the update a further study was added (147 participants) which altered the pooled results: duration in hospital may be increased for those who receive PN with additional glutamine - 0.22 days (95%CI (1.29 to 1.72). Two other studies reported that (73 participants) patients receiving PN plus glutamine had reduced incidence of positive blood cultures (OR 0.23, 95%CI 0.08 to 0.65, P = 0.006) compared to those receiving standard PN. However, a study from the update (113 participants in total) showed the odds of having a positive blood culture have increased but are still less likely if the patient receives PN with glutamine compared to standard PN (OR 0.46, 95%CI 0.20 to 1.04). When patients were given PN versus IV hydration, (25 participants) patients receiving PN had a higher incidence of line infections (OR 21.23, 95%CI 4.15 to 108.73, P = 0.0002) compared to those receiving standard IV fluids. The update identified one study which recognised that (55 participants) those who received IV were likely to spend less time in hospital, 3.30 days (95%CI -0.38 to 6.98, P = 0.08), although this result was not significant. As reported in the original review there remains no evaluable data to properly compare PN with EN.

AUTHORS' CONCLUSIONS

In this update an additional study that compared PN and Glutamine versus standard PN showed that the certain benefits of parenteral nutrition with added glutamine compared to standard PN for reducing hospital stay are no longer definite. When PN with glutamine is compared with standard PN, patients may not leave hospital earlier, but do have reduced incidence of positive blood cultures, than those receiving standard PN. Where possible use of intravenous fluids and oral diet should be considered as a preference to parenteral nutrition, however, in the event of a patient suffering severe gastrointestinal failure even with a trial of enteral feeding, PN with the addition of glutamine could be considered.

Authors+Show Affiliations

Royal College of Physicians, London, UK.Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford St, London, UK, WC1N 1EH.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28334434

Citation

Murray, Susan M., and Sima Pindoria. "WITHDRAWN: Nutrition Support for Bone Marrow Transplant Patients." The Cochrane Database of Systematic Reviews, vol. 3, 2017, p. CD002920.
Murray SM, Pindoria S. WITHDRAWN: Nutrition support for bone marrow transplant patients. Cochrane Database Syst Rev. 2017;3:CD002920.
Murray, S. M., & Pindoria, S. (2017). WITHDRAWN: Nutrition support for bone marrow transplant patients. The Cochrane Database of Systematic Reviews, 3, p. CD002920. doi:10.1002/14651858.CD002920.pub4.
Murray SM, Pindoria S. WITHDRAWN: Nutrition Support for Bone Marrow Transplant Patients. Cochrane Database Syst Rev. 2017 03 23;3:CD002920. PubMed PMID: 28334434.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - WITHDRAWN: Nutrition support for bone marrow transplant patients. AU - Murray,Susan M, AU - Pindoria,Sima, Y1 - 2017/03/23/ PY - 2017/3/24/pubmed PY - 2017/6/29/medline PY - 2017/3/24/entrez SP - CD002920 EP - CD002920 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev VL - 3 N2 - BACKGROUND: This is an update of the original Cochrane review published in Issue 2, 2002. Bone marrow transplantation involves administration of toxic chemotherapy and infusion of marrow cells. After treatment, patients can develop poor appetite, mucositis and gastrointestinal failure, leading to malnutrition. To prevent this, parenteral nutrition (PN) support is often first choice but is associated with increased risk of infection. Enteral nutrition (EN) is an alternative, as is addition of substrates. OBJECTIVES: To determine efficacy of EN or PN support for patients receiving bone marrow transplant. SEARCH METHODS: Search of The Cochrane Library, MEDLINE, EMBASE and CINAHL in November 2000 and subsequently June 2006. SELECTION CRITERIA: RCTs that compared one form of nutrition support with another, or control, for bone marrow transplant patients. DATA COLLECTION AND ANALYSIS: Twenty nine studies were identified. Data were collected on participants' characteristics; adverse effects; neutropaenia; % change in body weight; graft versus host disease; and survival. MAIN RESULTS: In two studies (82 participants) glutamine mouthwash reduced number of days patients were neutropenic (6.82 days, 95%CI (1.67 to 11.98) P = 0.009) compared with placebo. Three studies reported (103 participants) that patients receiving PN with glutamine had reduced hospital stay, 6.62 d (95%CI 3.47 to 9.77, P = 0.00004) compared with patients receiving standard PN. However, in the update a further study was added (147 participants) which altered the pooled results: duration in hospital may be increased for those who receive PN with additional glutamine - 0.22 days (95%CI (1.29 to 1.72). Two other studies reported that (73 participants) patients receiving PN plus glutamine had reduced incidence of positive blood cultures (OR 0.23, 95%CI 0.08 to 0.65, P = 0.006) compared to those receiving standard PN. However, a study from the update (113 participants in total) showed the odds of having a positive blood culture have increased but are still less likely if the patient receives PN with glutamine compared to standard PN (OR 0.46, 95%CI 0.20 to 1.04). When patients were given PN versus IV hydration, (25 participants) patients receiving PN had a higher incidence of line infections (OR 21.23, 95%CI 4.15 to 108.73, P = 0.0002) compared to those receiving standard IV fluids. The update identified one study which recognised that (55 participants) those who received IV were likely to spend less time in hospital, 3.30 days (95%CI -0.38 to 6.98, P = 0.08), although this result was not significant. As reported in the original review there remains no evaluable data to properly compare PN with EN. AUTHORS' CONCLUSIONS: In this update an additional study that compared PN and Glutamine versus standard PN showed that the certain benefits of parenteral nutrition with added glutamine compared to standard PN for reducing hospital stay are no longer definite. When PN with glutamine is compared with standard PN, patients may not leave hospital earlier, but do have reduced incidence of positive blood cultures, than those receiving standard PN. Where possible use of intravenous fluids and oral diet should be considered as a preference to parenteral nutrition, however, in the event of a patient suffering severe gastrointestinal failure even with a trial of enteral feeding, PN with the addition of glutamine could be considered. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/28334434/WITHDRAWN:_Nutrition_support_for_bone_marrow_transplant_patients_ L2 - https://doi.org/10.1002/14651858.CD002920.pub4 DB - PRIME DP - Unbound Medicine ER -