Intravenous branched chain amino acid trial in marrow transplant recipients.
Branched chain amino acids (BCAA) improve nitrogen balance and end-organ function in surgical patients, but are untested in marrow transplant recipients. We compared nitrogen balance, urinary 3-methylhistidine-to-creatinine ratio, upper arm anthropometry, serum prealbumin, and day to peripheral engraftment in a randomized, double-blinded trial between 45% (high-leucine) and 23% BCAA intravenous solutions in 40 adult leukemia patients for 1 month following allogeneic marrow transplantation. Nutritional support, provided at approximately 30 nonprotein calories/kg and 0.21 g nitrogen/kg ideal weight, did not differ between groups. Despite greater nitrogen loss and muscle breakdown evidenced by increased 3-methylhistidine-to-creatinine ratio and loss of arm muscle area by study end in the 45% BCAA, no statistical differences were observed when nitrogen balance was compared by week and within stress level as defined by organ and infectious complications. It is likely the patients in the 45% BCAA experienced greater metabolic stress by study end. Serum prealbumin and day posttransplant to peripheral engraftment also did not differ between groups. The chances (power) of this study exceeded 85% in detecting a difference in nitrogen balance of 2.5 g during study week 1 and 4.0 g during week 2. The power during week 3 was 77% for detecting a difference of 4.0 g, and it is unlikely that the true difference exceeds this magnitude. Thus, we did not find any evidence that intravenous BCAA-enriched solutions improved nitrogen balance during the first month after marrow transplantation.
Lenssen
P
P
Cheney
C L
CL
Aker
S N
SN
Cunningham
B A
BA
Darbinian
J
J
Gauvreau
J M
JM
Barale
K V
KV
D000293:Adolescent; D000328:Adult; D000596:Amino Acids / Q000097:blood; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D003404:Creatinine / Q000652:urine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007938:Leukemia / Q000378:metabolism / Q000628:therapy; D008297:Male; D008762:Methylhistidines / Q000652:urine; D008875:Middle Aged; D009132:Muscles / Q000378:metabolism; D009584:Nitrogen / Q000378:metabolism; D011897:Random Allocation; D013312:Stress, Physiological / Q000378:metabolism
D000596:Amino Acids; D000597:Amino Acids, Branched-Chain; D008762:Methylhistidines; D003404:Creatinine; C028118:3-methylhistidine; D009584:Nitrogen