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


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).


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.
Piccirillo
Nicola
N
Hematology Institute, Università Cattolica del Sarco Cuore, Rome, Italy. emacat@rm.unicatt.it
De Matteis
Silvia
S
Laurenti
Luca
L
Chiusolo
Patrizia
P
Sorà
Federica
F
Pittiruti
Mauro
M
Rutella
Sergio
S
Cicconi
Silvia
S
Fiorini
Alessia
A
D'Onofrio
Giuseppe
G
Leone
Giuseppe
G
Sica
Simona
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D005260:Female; D005973:Glutamine / Q000008:administration & dosage* / Q000494:pharmacology; D019337:Hematologic Neoplasms / Q000628:therapy; D006801:Humans; D007107:Immune System / Q000166:cytology / Q000187:drug effects / Q000254:growth & development; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa; D010288:Parenteral Nutrition; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D013280:Stomatitis / Q000517:prevention & control; D014182:Transplantation, Autologous
D005973:Glutamine