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. 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; timeframes 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. 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.

Measurement of Hyperglycemia and Impact on Health Outcomes in People With Cancer: Challenges and Opportunities

“…Equivocal findings were noted among studies that examined infection, with some finding an association (Derr et al, 2008; Hammer et al, 2009, Hammer et al, 2016; Hong et al, 2014; Ito et al, 2014; Jackson et al, 2012; Matias et al, 2013; Rentschler et al, 2010, Sheean et al, 2006; Soysal et al, 2012; Storey & Von Ah 2016; Weiser et al, 2004) and others not (Derr et al, 2009; Fuji et al, 2007; Garg et al, 2007; Hardy et al, 2010; Storey & Von Ah 2015). Inconsistent findings as it related to hyperglycemia and length of stay were found, some showing a relationship (Garg et al, 2007; Karnchanasorn et al, 2012; Sheean et al, 2013) and others not (Rentschler et al, 2010; Storey & Von Ah, 2015; Storey & Von Ah 2016). Some of the studies examined health-related outcomes that were not assessed in the others such as: morbidity, engraftment, number of neutropenic days and complete remission thus not allowing for comparison (Jackson et al, 2012; Karnchanasorn et al, 2012; Storey & Von Ah, 2015; Storey & Von Ah, 2016; Weiser et al, 2014).…”

“…The association between hyperglycemia and toxicity was found in each of the six studies that assessed this outcome (Brunello et al, 2010; Fuji et al, 2007; Fuji et al, 2009; Gebremedhin et al, 2012; Sheean et al, 2006; Sheean et al, 2013). Survival was also found to be linked to hyperglycemia in the two studies (Tieu et al, 2015; Villerear-Garza et al, 2012) that examined this outcome.…”

“…One study (3%) used > 130 mg/dL (Villarreal-Garza et al, 2012) and one (3%) used 140 mg/dL (Soysal et al, 2012). Five studies used multiple thresholds to define hyperglycemia (Brunello, Kapoor, & Extermann, 2011; Hardy, Nowacki, Bertin, & Weil, 2010; Sheean, Freels, Helton, & Braunschweig, 2006; Sheean, Kilkus, Liu, Maciejewski, & Braunschweig, 2013; Rentschler et al, 2010). Two authors categorized elevated blood glucose values into either quartiles (beginning at 106mg/dL) (Hong, et al, 2014) or ranges such as mild, moderate and severe beginning at 121 mg/dL (Jackson, Amdur, White, & Macsata, 2012).…”

“…Luo et al, 2012; Matias et al, 2013; Sheean, Freels, Helton, & Braunschweig, 2006; Sheean et al, 2013; Storey & Von Ah, 2015; Storey & Von Ah, 2016; Villarreal-Garza et al, 2012). Three studies used random blood glucose only (Derr et al, 2009; Soysal et al, 2012; Tieu et al, 2015).…”

Prevalence and impact of hyperglycemia on hospitalized leukemia patients

“…Subsequently ten additional studies have examined hyperglycemia on at least one of these clinical outcomes (Gebremedhin et al, 2012;Griffith et al, 2011;Jackson et al, 2012;Karnchanasorn et al, 2012;Matias et al, 2013;Pidala et al, 2011;Rentschler et al, 2010;Sheean et al, 2013;Soysal et al, 2012;Villareal-Garza et al, 2012). However, these studies are limited as 12/21 (57%) focused predominately on the BMT population.…”