title: Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT.
abstract: Parenteral nutrition (PN) exacerbates hyperglycemia, which is associated with increased morbidity and mortality in various cancer populations. By using a retrospective design, we examined incident hyperglycemia in PN and non-PN recipients and the associations with clinical events and 5-year survival in a cohort treated for myeloma with melphalan and auto-SCT (n=112). Clinical comparisons were made at admission, and 'before' and 'after' initiating PN to discern differences and temporality. Actual infusion times were used for PN patients; time frames based on mean PN infusion days were created for the non-PN recipients. Oral intake was lower 'before' in PN vs non-PN patients (P<0.001); however, no differences in mucositis, emesis, infections or transfusions were detected 'before.' Incident hyperglycemia (≥7.0 mmol/L) was significant 'after' PN initiation, and PN recipients experienced delays in WBC (P<0.05) and platelet engraftment (P=0.009), and required significantly greater RBC (P=0.0014) and platelet (P=0.001) support 'after' than non-PN patients. Neutropenic fever and longer hospital stay were more frequent among PN vs non-PN recipients (P<0.001). Differences in 5-year mortality were not apparent. The findings fail to support clinical benefits of PN administration during auto-SCT for myeloma. Further study is needed to discern if hyperglycemia or feeding per se was deleterious in this patient population.
authors: Institute for Health Policy and Research, University of Illinois at Chicago, Chicago, IL 60608, USA. psheea1@uic.edu
authors: P M
authors: PM
authors: Sheean
authors: J M
authors: JM
authors: Kilkus
authors: D
authors: D
authors: Liu
authors: J
authors: J
authors: Maciejewski
authors: C A
authors: CA
authors: Braunschweig
mesh_terms: D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000178:diet therapy / Q000601:surgery*; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome