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

Abstract

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.

A randomized controlled trial of alanyl-glutamine supplementation in peritoneal dialysis fluid to assess impact on biomarkers of peritoneal health

“…43 Previous studies on the use of AlaGln supplementation in parenteral infusion regimens have provided data on systemic outcome parameters in patients in a hypercatabolic or hypermetabolic state or both that might also be relevant in the setting of PD. 35,[44][45][46][47] Given this clinical evidence and considering the adequate peritoneal absorption, it was not unexpected that AlaGln added to PDF also showed systemic effects in PD patients. Accordingly, we found a lower IL-8 concentration and a trend to lower hs-CRP concentrations during treatment with AlaGln compared with placebo.…”

Glutamine and its use in selected oncology settings

“…23 A possible trend in the objective reduction of mucositis by glutamine supplementation in non-BMT patients receiving chemotherapy and/or radiotherapy has been reported. 37 Furthermore, a Japanese study 38 using a combination of GLN, fibre and oligosaccharides (GFO) was the first retrospective comparative clinical study of mucosal injury in allogeneic HSCT using GFO. Iyama et al concluded that GFO supplementation was an effective supportive therapy to decrease the severity of mucosal injury in HSCT.…”

Tratamiento y prevención de la mucositis oral asociada al tratamiento del cáncer

“…Aunque hay estudios con resultados alentadores y recomendaciones de expertos 46 , la controversia respecto de su utilidad y seguridad continúa 42,47,48 . Recientemente fue publicado un metaanálisis respecto del uso glutamina suplementaria en quimioterapia no asociada a trasplante de médu-la osea 49 . Este trabajo no presenta las fortalezas metodológicas mencionadas más arriba: la bús-queda se describe escuetamente como "una breve búsqueda en Pubmed", no hay revisión explícita ni independiente de la calidad de los trabajos originales y uno de ellos fue eliminado del análisis por defi ciencias metodológicas que no están descritas.…”