Parenteral nutrition and cyclosporine: do lipids make a difference? A prospective randomized crossover trial

Santos, Paula Moura; Lourenço, Richard De Abreu; Camilo, M.; Oliveira, António G.; Figueira, I.; Pereira, MF; Ferreira, B. Bohn Damasceno; Carmo, J. Alves do; Lacerda, J.M.F.

doi:10.1054/clnu.2000.0151

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…Five patients in the control group, however, died of acute GVHD compared to none in the lipid-based group, possibly due to improved activity of immunosuppressive therapy with a higher lipid dose. Santos and co-workers, 37 however, showed no effect on cyclosporine pharmacokinetics between lipid-enriched (30%) and lipid-free TPN when given to 10 allogeneic HSCT patients.…”

Section: Lipidsmentioning

confidence: 96%

Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo?

Arfons

Lazarus

2005

Bone Marrow Transplant

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Summary:A majority of patients undergoing hematopoietic stem cell transplantation (HSCT) suffer from severe mucositis and enteritis due to cytotoxic therapy and immune dysregulation, resulting in prolonged decreased oral intake, nausea, vomiting and diarrhea. While total parenteral nutrition (TPN) is often given to patients in order to maintain their nutritional status during the peritransplant period, there is conflicting evidence to support its routine use. We evaluated the small number of prospective randomized and nonrandomized controlled trials that assessed important clinical outcomes such as time to engraftment, rates of infection, overall survival and length of hospitalization. We believe that the data do not support the routine use of parenteral nutrition as first-line therapy but should be reserved for those patients who are unable to tolerate enteral feedings. We also believe that glutamine supplementation cannot be recommended to all HSCT recipients as it has been shown to increase morbidity and mortality rates in autologous transplant patients. Further investigations that test accurate monitoring assessments and incorporate specific substrates such as lipids with parenteral and enteral nutrition are warranted. Novel therapies such as recombinant human keratinocyte growth factor and glucagon-like peptide show future promise in modulating the severity and duration of mucositis, minimizing further the need for TPN. Bone Marrow Transplantation (2005) 36, 281-288.

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Section: Lipidsmentioning

confidence: 96%

Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo?

Arfons

Lazarus

2005

Bone Marrow Transplant

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“…Cyclosporine has a narrow therapeutic index and various toxic effects, mostly concentration dependent and pharmacokineticly related to patient or co-medication characteristic s [171]. Failure or delay to reach target levels can result in both serious immunologic hazards such as GvHD or poor engraftment and toxicities like kidney injury, hypertension, hyperglycemia, CNS toxicities or infectious complications although some of them may occur at therapeutic levels [15,[172][173].…”

Section: Pharmacokinetic-related Adverse Effectsmentioning

confidence: 99%

Cyclosporine use in Hematopoietic Stem Cell Transplantation: Pharmacokinetic Approach

Tafazoli

2015

Immunotherapy

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Cyclosporine is one of the most vital agents in the process of successful allogeneic hematopoietic stem cell transplantation. Despite a long history and worldwide extent of cyclosporine use for prevention of graft versus host disease, currently there are lots of uncertainties about its optimal method of application to reach the best clinical outcome. A major portion of this problem stems from complicated cyclosporine pharmacokinetics. Study of cyclosporine pharmacokinetic behavior can significantly help recognition of its effectiveness and consequently, optimization of dosing, administration, monitoring and management of adverse effects. In this review, highly accredited but sparse scientific data are gathered in order to provide a better insight for preparation of practice guidelines and directing future studies for allogeneic hematopoietic cell recipients.

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“…It has not been conclusively determined whether the tip of the catheter is better positioned in the superior vena cava or in the right atrium [62], [63], [64], [65]. However, pericardial tamponades, cardiac arrhythmia, heart lesions and thromboses have been described when the catheter tip has been positioned in the atrium, rendering this an obsolete position.…”

Section: Central Venous Accessmentioning

confidence: 99%

“…Clinically relevant catheter-associated thromboses are late complications of long-term PN [63], [64], [65]. Catheter occlusions can occur because of the generation of fibrin or thrombin build-up or partial or total parietal thrombosis [158].…”

Section: Central Venous Accessmentioning

confidence: 99%

Access technique and its problems in parenteral nutrition – Guidelines on Parenteral Nutrition, Chapter 9

Jauch¹,

Schregel²,

Stanga³

et al. 2009

GMS German Medical Science; 7:Doc19; ISSN 1612-3174

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Parenteral nutrition and cyclosporine: do lipids make a difference? A prospective randomized crossover trial

Cited by 9 publications

References 22 publications

Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo?

Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo?

Cyclosporine use in Hematopoietic Stem Cell Transplantation: Pharmacokinetic Approach

Access technique and its problems in parenteral nutrition – Guidelines on Parenteral Nutrition, Chapter 9

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