Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study.
OBJECTIVE
To determine whether glutamine-supplemented parenteral nutrition improves nitrogen retention and reduces hospital morbidity compared with standard parenteral nutrition after bone marrow transplantation.


METHODS
Double-blind, randomized, controlled clinical trial.


METHODS
University teaching hospital.


METHODS
Forty-five adults receiving allogeneic bone marrow transplants for hematologic malignancies.


METHODS
Parenteral nutrition was initiated the day after bone marrow transplantation (day 1). The experimental solution was supplemented with L-glutamine (0.57 g/kg body weight per day) and provided estimated requirements for energy and protein. The control solution was a standard, glutamine-free, isonitrogenous, isocaloric formula.


METHODS
Nitrogen balance was determined between days 4 and 11 in the initial 23 patients. The incidence of clinical infection and microbial colonization, time until bone marrow engraftment, indices of clinical care, and other data related to hospital morbidity were recorded for all patients.


RESULTS
The glutamine-supplemented patients (n = 24) were clinically similar to the controls (n = 21) at entry. Nutrient intake was similar in both groups; however, nitrogen balance was improved in the glutamine-supplemented patients relative to the controls (-1.4 +/- 0.5 g/d compared with -4.2 +/- 1.2; P = 0.002). Fewer experimental patients developed clinical infection (three compared with nine in the control group; P = 0.041), and the incidence of microbial colonization was also significantly reduced. Hospital stay was shortened in patients receiving glutamine supplementation (29 +/- 1 d compared with 36 +/- 2 d; P = 0.017).


CONCLUSIONS
Patients receiving glutamine-supplemented parenteral nutrition after bone marrow transplantation had improved nitrogen balance, a diminished incidence of clinical infection, lower rates of microbial colonization, and shortened hospital stay compared with patients receiving standard parenteral nutrition. These effects occurred despite no differences between groups in the incidence of fever, antibiotic requirements, or time to neutrophil engraftment.
Ziegler
T R
TR
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215.
Young
L S
LS
Benfell
K
K
Scheltinga
M
M
Hortos
K
K
Bye
R
R
Morrow
F D
FD
Jacobs
D O
DO
Smith
R J
RJ
Antin
J H
JH
D000328:Adult; D016026:Bone Marrow Transplantation / Q000276:immunology / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism; D009894:Opportunistic Infections / Q000517:prevention & control; D010288:Parenteral Nutrition / Q000379:methods*; D011446:Prospective Studies
D005973:Glutamine; D009584:Nitrogen