Effect of low-dose oral glutamine on painful stomatitis during bone marrow transplantation

Abstract

Summary:Painful oral mucositis is a common complication after bone marrow transplantation (BMT). Glutamine is a nutrient for rapidly dividing cells and the major energy source for intestinal epithelium. This study tested whether an oral glutamine preparation could decrease the severity of oral mucositis in patients undergoing BMT. Glutamine or a placebo (glycine) were administered from admission until day +28 in 193 BMT patients in a randomized, double-blind, placebo-controlled study at a dose of 1.0 g amino acid/m 2 /dose swish and swallow four times a day. In autologous BMT patients (n = 87) glutamine was associated with significantly less mouth pain by self report and by opiate use (5.0 ؎ 6.2 days of morphine for glutamine vs 10.3 ؎ 9.8 days for placebo; P = 0.005). Matched sibling BMT patients had no effect by self report and an increased duration of opiate use (23.2 ؎ 5.7 days for glutamine vs 16.3 ؎ 8.3 days for placebo) (P = 0.002). However, day 28 survival of allogeneic patients was improved by glutamine. No significant differences in TPN use, rate of relapse or progression of malignancy, parenteral antibiotic use, acute or chronic GVHD, or days of hospitalization were observed in either autologous or allogeneic recipients. No toxicity of glutamine was observed. We conclude that oral glutamine can decrease the severity and duration of oropharyngeal mucositis in autologous BMT patients but not in allogeneic BMT patients, possibly due to interaction with methotrexate. Keywords: mucositis; stomatitis; supportive care; nutrition; epithelium; chemotherapy Many of the major adverse effects of BMT are related to disruption of mucosal integrity from high-dose chemotherapy and/or radiation-induced damage of oral and intestinal epithelium. Preclinical studies have demonstrated less damage to rat intestinal epithelium if high doses of enteral glutamine were included in the diet during and after 1000 cGy of whole abdominal radiation. [1][2][3] Glutamine is the most abundant amino acid in the blood, but is generally absent Correspondence: Dr P Anderson, Pediatrics-East 9, Mayo Clinic, Rochester, MN 55905, USA Received 7 November 1997; accepted 16 March 1998 from total parenteral nutrition (TPN) for solubility and stability reasons. [4][5][6][7] The intestine utilizes glutamine as its primary energy source, and glutamine has been shown to be an essential dietary component for support and maintenance of intestinal growth and function. 8-10 Supplementation of TPN with glutamine has been shown to decrease villous atrophy associated with exclusive feeding via TPN. 11,12 Nutritionally depleted patients have been shown to have decreased plasma glutamine and mucosal glutamine. 13 Recent studies have also demonstrated a survival advantage of TPN supplementation with glutamine in critically ill patients. 14 Since no information was available concerning the effect of oral glutamine on the squamous epithelium of the oropharynx after chemotherapy and/or radiation, we conducted an earlier pilot study using oral glutamine 4 g/m 2 t...

Autologous Peripheral Blood Hematopoietic Cell Transplantation in Dogs with T‐Cell Lymphoma

“…Therefore, we administered >10 Gy TBI to 12 dogs while incorporating more fractionated protocols in an effort to decrease the associated GI toxicities. In addition, many dogs received enteral glutamine, an antioxidant that may protect the GI tract from the adverse effects associated with radiation treatment 19, 20. Although 2 dogs in this study died in the hospital, only 1 dog, that was not in CR at the time of presentation to NCSU and subsequently received high‐dose chemotherapy 1 week before TBI, had evidence of severe GI toxicity at necropsy.…”

Dietary Supplement Use in Cancer Care: Help or Harm

“…In one study where it was examined [116], glutamine did not increase the relapse rate, progression of malignancy, or incidence of graft-versus-host disease.…”

“…Glutamine was also beneficial for children undergoing autologous bone marrow transplant when given at a dose of 1 g/m 2 four times a day throughout the transplant and for 28 days afterwards [116]. Subjects reported less pain and used morphine half as many days (P ¼ .005).…”

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

“…Anderson i wsp. [55] stwierdzili, że glutamina podawana dojelitowo (4 g/dobę) w grupie 193 chorych (nie selekcjonowano pacjentów pod względem choroby i wieku) zmniejszała ból spowodowany zapaleniem bło-ny śluzowej jamy ustnej i skracała czas podawania morfiny w stosunku do placebo, ale tylko po autologicznych przeszczepach krwiotwórczych komórek macierzystych. Inne badania wykonane u 124 chorych z białaczką i nowotworem piersi nie wykazały natomiast działania dojelitowo stosowanej glutaminy (30 g/dobę), zarówno po autologicznym, jak i alogenicznym przeszczepieniu krwiotwórczych komórek macierzystych [56,57].…”