Hyperalimentation in autologous bone marrow transplantation for solid tumors. Comparison of total parenteralVersus partial parenteral plus enteral nutrition

Abstract

Recipients of autologous bone marrow transplantation (ABMT) for solid tumors need nutritional support to maintain their body weight (BW). Severe BW-reduction (9.9%) was noticed retrospectively in ten ABMT patients fed orally, despite intensive counseling or occasional tube feeding. A prospective, ran-domized study of hyperalimentation (25 g nitrogen (N) and 3400 nonprotein kilocalories) with total par-enteral nutrition (TPN) or partial parenteral plus enteral nutrition by tube feeding (PPN/EN) was done in 22 patients. Nutritional assessment included balance measurements of N, Na, K, CI, P, Ca, Mg, Cu, and Zn, and serial measurements of BW, serum albumin, prealbumin, and transferrin. Both regimens were effective in maintaining BW (maximum percent of change, 2.5) and N-balance. Blood products accounted for an additional N-intake of 13% in both groups. The TPN group had a higher dietary N-intake versus PPN/EN, a positive K balance but negative Ca, Mg, Cu, and Zn balances. More mineral supplementation was given in the PPN/EN group where positive K, Mg, and Zn balances were seen. Visceral proteins and IgG, IgA, and IgM levels were decreased on days 7,14, and 21. Creatinine clearance increased significantly in both groups. Compared with TPN, the PPN/EN group showed a twofold number of patients with a positive blood culture, although this observation did not reach statistical significance and patients had fewer days of diarrhea (31.1 % versus 54.3%, P < 0.01). Hyperalimentation with PPN/ EN is an acceptable alternative to TPN in the nutritional support of ABMT recipients.

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

“…There were 17 eligible studies on patients undergoing chemotherapy or radiotherapy for inclusion in the review, including 8 RCTs (77,79,87,94,95,97,107,109) and 6 non-RCTs (78,81,92,105,121,128) comparing nutritional support with routine care, 2 RCTs comparing EPA supplementation (capsules) with routine care (47,74), and 1 RCT comparing ETF with PN (108). The majority of studies (n=12) utilised ONS, with only 5 studies using ETF (78,81,92,108,121). The type of cancer varied widely and included head/neck (77,109,121,128), abdominal/ pelvic (79,87,94,97), lung (128), breast (95,105), gastrointestinal (81), leukaemia (47,74,92), or a variety of sites (78,107,108).…”

“…The type of cancer varied widely and included head/neck (77,109,121,128), abdominal/ pelvic (79,87,94,97), lung (128), breast (95,105), gastrointestinal (81), leukaemia (47,74,92), or a variety of sites (78,107,108). Three of the studies were on patients undergoing bone marrow transplantation (47,74,108).…”

Parenteral nutrition following intensive cytotoxic therapy: an exploratory study on the need for parenteral nutrition after various treatment approaches for haematological malignancies

“…Clinical trials on the efficacy of PNS in BMT patients 5,19,20 are scarce and mainly performed in selected groups, not allowing extrapolation to other subgroups.…”

“…Parenteral nutrition support (PNS) was believed to be indispensible in bridging the period of severe gastrointestinal toxicity and pancytopenia. [3][4][5][6][7][8] Despite this, the efficacy of PNS on treatment tolerance or prognosis has never been demonstrated. Recent developments, such as the advent of improved antiemetics and haematopoietic growth Correspondence: JA Iestra, Center for Rehabilitation and Nutritional Sciences, University Hospital Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands Received 23 July 1998; accepted 3 December 1998 factors, have shortened the period of reduced oral food intake.…”

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

“…The risks and benefits of using PN in HCT have been assessed comparing PN vs SOD [146][147][148][149] or EN [150][151][152] vs PN vs intravenous fluids (IVF) alone. [153][154][155] Studies of PN vs SOD or EN demonstrate increased morbidity, 146 more diarrhea, 150 more hyperglycemia, 151,152 and delayed time to engraftment 149,152 but less weight loss 146,147 and less loss of body fat 148 with PN. There appear to be no differences in incidence or severity of GVHD.…”