Supplementation with concentrated milk protein in patients undergoing hematopoietic stem cell transplantation

Perrone, Ana Carolina Amaral de São José; Barbosa, Thaís Rodrigues; Silva, Fernanda Lopes da; Perrone, Ítalo Tuler; Carvalho, Antônio Fernandes de; Stephani, Rodrigo; Santos, Kelli Borges dos; Atalla, Ângelo; Neto, Abrahão Elias Hallack

doi:10.1016/j.nut.2016.10.010

Cited by 10 publications

(8 citation statements)

References 44 publications

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“…The neutropenia duration was approximately 9 days, similar to the previously work performed by our group (2017) [18], in which a nutritional supplementation was applied to patients undergoing HSCT and shows overall mean duration of neutropenia of 9.87 days varying 6.80 days.…”

Section: Discussionsupporting

confidence: 86%

Incidence of mucositis in patients undergoing autologous hematopoietic stem cell transplantation at a single center

Perrone¹,

Cunha²,

Pinheiro³

et al. 2020

jbmtct

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Goal: The aim of this study was to describe the incidence of oral mucositis (OM) in patients undergoing autologous hematopoietic stem cell transplantation (auto-HSCT), relating it to the main clinical factors. Methodology: Descriptive analysis based on a randomized clinical study was conducted with patients undergoing HSCT at the University Hospital of Federal University of Juiz de Fora between January 2018 and June 2019. The World Health Organization oral toxicity scale was used to assess the degree of oral mucositis and adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) 4.0 version. Results: Thirty-eight patients were evaluated. The incidence of OM and severe oral mucositis (SOM) was 57.9% and 21.0%, respectively. The mean duration of OM was 7.2 ± 2.6 days and the lomustine, etoposide, cytarabine and cyclophosphamide protocol (LEAC) presented the longest mean time 8.1 ± 3.1 days (p-value 0.02). The number of viable CD34+ cells and the onset day of neutropenia were predictors of SOM. Conclusion: The incidence of OM in patients undergoing HSCT was lower than reported in the literature, being more severe in patients who received less CD34+ cells and in patients with early onset of neutropenia.

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Section: Discussionsupporting

confidence: 86%

Incidence of mucositis in patients undergoing autologous hematopoietic stem cell transplantation at a single center

Perrone¹,

Cunha²,

Pinheiro³

et al. 2020

jbmtct

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“…Some interventions, such as that of clarithromycin (221), celecoxib (92, 114), Chinese herbal medicine (89), whey protein concentrate (147), dexamethasone mouth wash (157) and TGF-β2 (43), have been subject to trials in humans, but have not yet resulted in general recommendations. Some authors suggested beneficial effects of IL-11 therapy (48) but others reported a high rate of toxicity and mortality in a small group of patients given the same dose of rhIL-11 (11).…”

Section: Models Of Cim In Rodents Strengths and Limitationsmentioning

confidence: 99%

Animal models of chemotherapy-induced mucositis: translational relevance and challenges

Sangild

Shen

Pontoppidan

et al. 2018

American Journal of Physiology-Gastrointestinal and Liver Physi

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Chemotherapy for cancer patients induces damaging tissue reactions along the epithelium of the gastrointestinal tract (GIT). This chemotherapy-induced mucositis (CIM) is a serious side effect of cytotoxic drugs, and several animal models of CIM have been developed, mainly in rodents and piglets, to help understand the progression of CIM and how to prevent it. Animal models allow highly controlled experimental conditions, detailed organ (e.g., GIT) insights, standardized, clinically relevant treatment regimens, and discovery of new biomarkers. Still, surprisingly few results from animal models have been translated into clinical CIM management and treatments. The results obtained from specific animal models can be difficult to translate to the diverse range of CIM manifestations in patients, which vary according to the antineoplastic drugs, dose, underlying (cancer) disease, and patient characteristics (e.g., age, genetics, and body constitution). Another factor that hinders the direct use of results from animals is inadequate collaboration between basic science and clinical science in relation to CIM. Here, we briefly describe CIM pathophysiology, particularly the basic knowledge that has been obtained from CIM animal models. These model studies have indicated potential new preventive and ameliorating interventions, including supplementation with natural bioactive diets (e.g., milk fractions, colostrum, and plant extracts), nutrients (e.g., polyunsaturated fatty acids, short-chain fatty acids, and glutamine), and growth factor peptides (e.g., transforming growth factor and glucagon-like peptide-2), as well as manipulations of the gut microbiota (e.g., prebiotics, probiotics, and antibiotics). Rodent CIM models allow well-controlled, in-depth studies of animals with or without tumors while pig models more easily make clinically relevant treatment regimens possible. In synergy, animal models of CIM provide the basic physiological understanding and the new ideas for treatment that are required to make competent decisions in clinical practice.

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“…No effect was found on mucositis. However, subgroup analysis suggested beneficial effects on duration and severity of oral mucositis in patients receiving the highest amounts of the protein supplement . A possible protective effect on the gastrointestinal mucosa of milk bioactives is supported by animal studies in rodents, in which administration of factors from bovine milk or whey has shown beneficial effects against chemotherapy‐induced gut damage .…”

Section: Discussionmentioning

confidence: 99%

“…However, subgroup analysis suggested beneficial effects on duration and severity of oral mucositis in patients receiving the highest amounts of the protein supplement. 34 A possible protective effect on the gastrointestinal mucosa of milk bioactives is supported by animal studies in rodents, in which administration of factors from bovine milk or whey has shown beneficial effects against chemotherapy-induced gut damage. 35,36 Most of the proposed beneficial compounds in milk are present in higher concentration in colostrum, compared with mature milk, and whole bovine colostrum has been suggested as a possible intervention against chemotherapy-induced mucositis.…”

Section: Discussionmentioning

confidence: 99%

Bovine Colostrum Against Chemotherapy‐Induced Gastrointestinal Toxicity in Children With Acute Lymphoblastic Leukemia: A Randomized, Double‐Blind, Placebo‐Controlled Trial

Rathe

Pietri

Wehner

et al. 2019

J Parenter Enteral Nutr

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Background The toxic effect of chemotherapy on the gastrointestinal tract may lead to mucositis and is associated with the pathogenesis of other treatment‐related complications. We hypothesized that nutrition supplementation with bovine colostrum, rich in bioactive factors, would ameliorate gastrointestinal toxicity and reduce the incidence of fever and infectious complications during induction treatment for childhood acute lymphoblastic leukemia (ALL). Methods Children with newly diagnosed ALL were included in a 2‐center, randomized, double‐blind, placebo‐controlled clinical trial. Patients were randomized to receive a daily colostrum or placebo supplement during 4 weeks of induction treatment. Data on fever, bacteremia, need for antibiotics, and mucosal toxicity were prospectively collected. (Trial registration: http://www.clinicaltrials.gov NCT01766804). Results Sixty‐two patients were included. No differences were found for the primary outcome (number of days with fever). No difference was observed for neutropenic fever, intravenous antibiotics, or incidence of bacteremia. Peak severity of oral mucositis was significantly reduced by colostrum (7/29 patients, 24% mild; 6/29, 21% moderate; 1/29, 3% severe) compared with placebo (12/31, 39% mild; 1/31, 3% moderate; 7/31, 23% severe) (P = 0.02). Among patients receiving at least 1 dose of supplement (colostrum: n = 22; placebo: n = 30), the peak weekly self‐reported oral mucositis score was overall significantly less severe in the colostrum group (P = 0.009). Conclusion The use of prophylactic bovine colostrum showed no effect on fever, infectious morbidity, or inflammatory responses. Nevertheless, these data may suggest protective effects on the oral mucosa during induction therapy in childhood ALL, encouraging additional studies confirming these findings.

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Supplementation with concentrated milk protein in patients undergoing hematopoietic stem cell transplantation

Abstract: WPC intake ≥40% of DPR helped to reduce the severity and duration of OM. The use of WPC in patients undergoing HSCT was shown to be safe, encouraging new studies in this population to assess its action mechanism.

Cited by 10 publications

References 44 publications

Incidence of mucositis in patients undergoing autologous hematopoietic stem cell transplantation at a single center

Incidence of mucositis in patients undergoing autologous hematopoietic stem cell transplantation at a single center

Animal models of chemotherapy-induced mucositis: translational relevance and challenges

Bovine Colostrum Against Chemotherapy‐Induced Gastrointestinal Toxicity in Children With Acute Lymphoblastic Leukemia: A Randomized, Double‐Blind, Placebo‐Controlled Trial

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