title: Glutamine-enriched parenteral nutrition after autologous peripheral blood stem cell transplantation: effects on immune reconstitution and mucositis.
abstract: 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.
authors.affiliation: Hematology Institute, Università Cattolica del Sarco Cuore, Rome, Italy. emacat@rm.unicatt.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Piccirillo
authors.forename: Silvia
authors.initials: S
authors.lastname: De Matteis
authors.forename: Luca
authors.initials: L
authors.lastname: Laurenti
authors.forename: Patrizia
authors.initials: P
authors.lastname: Chiusolo
authors.forename: Federica
authors.initials: F
authors.lastname: Sorà
authors.forename: Mauro
authors.initials: M
authors.lastname: Pittiruti
authors.forename: Sergio
authors.initials: S
authors.lastname: Rutella
authors.forename: Silvia
authors.initials: S
authors.lastname: Cicconi
authors.forename: Alessia
authors.initials: A
authors.lastname: Fiorini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Onofrio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Leone
authors.forename: Simona
authors.initials: S
authors.lastname: Sica
mesh_terms: 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
chemical_list: D005973:Glutamine