Oral and Parenteral Glutamine in Bone Marrow Transplantation: A Randomized, Double‐Blind Study

Schloerb, Paul R.; Skikne, Barry S.

doi:10.1177/0148607199023003117

Cited by 136 publications

(80 citation statements)

References 20 publications

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“…In order to achieve this the glutamine needed to be mixed in 100 ml of sterile water per 10 g of Lglutamine. This corresponds to the dilution used by Schloerb and Skikne (1999). The maximum acceptable volume of suspension was 300 ml in the larger patients taking the higher doses of glutamine.…”

Section: Discussionmentioning

confidence: 99%

“…Glutamine added to parenteral nutrition has been shown to help prevent intestinal atrophy and to maintain gut integrity (Tremel et al, 1994;van der Hulst et al, 1993). Studies in adult oncology patients have shown that glutamine given orally is well tolerated (Skubitz & Anderson, 1996;Jebb et al, 1995;Schloerb & Skikne, 1999). In one such study a significant decrease in the severity of chemotherapy induced stomatitis was seen using a 'swish and swallow' technique (Skubitz & Anderson, 1996).…”

Section: Introductionmentioning

confidence: 99%

“…In one such study a significant decrease in the severity of chemotherapy induced stomatitis was seen using a 'swish and swallow' technique (Skubitz & Anderson, 1996). Doses of glutamine given to adult patients vary from 0.2 to 0.57 g glutamine=kg=day (Ziegler et al, 1992;Skubitz & Anderson, 1996;Jebb et al, 1995;Schloerb & Skikne, 1999). There is only one published study of oral glutamine involving paediatric oncology patients (Anderson et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

“…The starting dose of glutamine chosen was 0.35 g=kg, which was within the range most commonly used in adult studies (Ziegler et al, 1992;Skubitz & Anderson, 1996;Jebb et al, 1995;Schloerb & Skikne, 1999).…”

Section: Introductionmentioning

confidence: 99%

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Oral glutamine in paediatric oncology patients: a dose finding study

et al. 2003

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Objective: The purpose of this study was to determine the most appropriate dose of oral glutamine to use in a further clinical study in paediatric oncology patients. Design: This was a phase I, pharmokinetic study. Setting: The study was carried out at The Yorkshire Regional Centre for Paediatric Oncology and Haematology, St James's University Hospital, Leeds, UK. Subjects: Thirteen patients undergoing treatment for paediatric malignancy participated in this study. All 13 completed the study. Interventions: The most appropriate dose was determined by patient acceptability and by plasma glutamine and ammonia levels measured at timed intervals after ingestion of a single glutamine dose. Results: Doses of 0.35, 0.5 and 0.65 g=kg were well tolerated with no untoward plasma glutamine and ammonia levels. One patient was recruited to a higher dose of 0.75 g=kg, but the plasma glutamine and ammonia levels peaked at 2601 and 155 mmol=l, respectively. The ammonia level was greater than the acceptable upper limit. It was difficult to disperse the glutamine adequately at this dose, resulting in the suspension being found to be unpalatable and therefore no further patients were recruited at this dose. Conclusion: It was concluded that 0.65 g=kg is a safe dose of glutamine to use in a clinical study in paediatric oncology patients. Sponsorship: Scientific Hospital Supplies UK Ltd provided the L-glutamine and financial help for the biochemical analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oral glutamine in paediatric oncology patients: a dose finding study

et al. 2003

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“…Briefly, the search has produced seventeen (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) randomised controlled trials, of which seven used oral glutamine (22)(23)(24)(25)(26)(27)(28) and ten used intravenous glutamine (29)(30)(31)(32)(33)(34)(35)(36)(37)(38) . Five studies investigated autologous transplantation (24,26,30,32,33) while four investigated allogeneic transplantation (27,29,34,38) and seven were mixed transplant types (22,23,25,28,31,35,37) . Considerabl...…”

Section: Bone-marrow Transplantationmentioning

confidence: 99%

Symposium 4: Hot topics in parenteral nutrition A review of the use of glutamine supplementation in the nutritional support of patients undergoing bone-marrow transplantation and traditional cancer therapy

Crowther

2009

Proc. Nutr. Soc.

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The relationship between glutamine and malignancy can be traced back to the 1950s and the requirement for glutamine for malignant-cell growth in culture. Later studies demonstrated an association between the rate of proliferation of the malignant cells and glutamine usage. The excessive use of glutamine by malignant cells was seen as an opportunity for the development of a treatment using glutamine analogues, but unfortunately excessive toxicity was observed during clinical studies. In animal models glutamine supplementation, initially thought to increase tumour growth, actually causes tumour regression as a result of improved immune clearance of the tumour and appears to reduce the severity of the side effects of chemo- and radiotherapy. This finding led to human studies in both traditional cancer therapy and bone-marrow transplantation, which are reviewed here. Unfortunately, the majority of the studies performed are small and have poor methodological reporting. There is clinical heterogeneity in terms of routes of administration, dosing schedules, chemotherapy regimens and diseases. Studies of glutamine in non-bone-marrow transplantation chemo- and/or radiotherapy treatment suggest a possible trend towards reductions in objective mucositis but no effect on subjective symptoms. There is no evidence for its effect on other clinical outcomes. For bone-marrow transplantation there appears to be some benefit from oral glutamine in reducing mucositis and graft v. host disease, while intravenous glutamine may reduce infections but at the expense of an increased relapse rate. Good-quality studies are required in this area.

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