Citrulline-based assessment score: first choice for measuring and monitoring intestinal failure after high-dose chemotherapy.
BACKGROUND
Currently, objective tests are lacking that enable the extent and duration of intestinal mucosal damage induced by myeloablative chemotherapy to be determined. To address this problem, we explored a citrulline-based assessment score as this amino acid is a simple quantitative marker of intestinal failure.


METHODS
From March 2004 to June 2007, citrulline concentrations were determined at baseline and at least once weekly after the start of myeloablative chemotherapy until 30 days thereafter among 94 allogeneic or autologous haematopoietic stem-cell transplant recipients. The patients were divided into three groups according to the regimen they received: (i) carmustine, etoposide, cytarabine and melphalan/high-dose melphalan, (ii) cyclophosphamide and total body irradiation +/- antithymocyte globulin and (iii) idarubicin-containing regimens. Intestinal mucosal damage was described either by level of citrulline on each day, on the basis of different thresholds of citrulline indicating the severity of villous atrophy, or by area under the curve using reciprocal value of 10/citrulline.


RESULTS
Regimens that incorporated idarubicin induced the most severe intestinal toxicity. Scores based on the level of citrulline, using severity thresholds, and on the area under the reciprocal curve are able to discriminate between the damage induced by different high-dose chemotherapy regimens.


CONCLUSIONS
A citrulline-based assessment score appears objective, validated, reproducible, reliable, specific and sensitive making it a suitable first choice for measuring and monitoring intestinal mucositis.
Herbers
A H
AH
Department of Haematology. Electronic address: A.Herbers@hemat.umcn.nl.
Feuth
T
T
Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Donnelly
J P
JP
Department of Haematology.
Blijlevens
N M
NM
Department of Haematology.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002956:Citrulline / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007422:Intestines / Q000187:drug effects* / Q000503:physiopathology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning; D055815:Young Adult
D000970:Antineoplastic Agents; D002956:Citrulline