Total Parenteral Nutrition With Glutamine in Bone Marrow Transplantation and Other Clinical Applications (A Randomized, Double‐Blind Study)

Abstract

In a paper by Ziegler et al (Ann Intern Med 116: 821-828, 1992), total parenteral nutrition supplemented with L-glutamine (TPN/GLN) was reported beneficial in patients receiving bone marrow transplantation (BMT) for hematologic malignancies. By using a similar protocol, we studied 29 patients with both hematologic malignancies and solid tumors, and with both allogeneic and autologous BMTs. In a double-blind, randomized approach, patients were given isocaloric, isonitrogenous TPN after BMT until they consumed 50% of their required diet orally. Total body water and extracellular water were measured before and after TPN in 10 patients. Total body water increased in patients receiving standard TPN and decreased significantly in patients receiving TPN/GLN. Length of hospital stay after BMT was significantly (5.8 days) less in patients receiving TPN/GLN. Incidence of positive bacterial cultures, clinical infections, and mortality did not differ significantly between the two groups. When the groups were subdivided into patients with hematologic malignancies and those with solid tumors, there were no significant differences in the above variables associated with TPN/GLN. In 17 of 30 additional hospitalized patients receiving standard TPN, substitution of TPN/GLN did not have discernible clinical or laboratory effects but appeared to be safe. Inclusion of patients with solid tumors and a higher mortality in our patients may have obscured beneficial effects of TPN/GLN observed by others.

5-fluorouracil and folinic acid-induced mucositis: no effect of oral glutamine supplementation

“…However. recent human studies which have shown positive benefits have given 0.57 g of glutamine per kg, more than twice the dose in this study (Ziegler et al, 1992;Schloerb & Amare. 1993), and via the intravenous route.…”

Body weight recovery, eating difficulties and compliance with dietary advice in the first year after stem cell transplantation: a prospective study

“…Over the past decade there have been several publications [1][2][3][4][5] on nutritional support strategies during the clinical treatment phase of blood cell transplant recipients. Less attention has been paid to body weight recovery and eating problems in the post-hospital phase.…”

A double-blind randomized placebo-controlled study of oral glutamine in the prevention of mucositis in children undergoing hematopoietic stem cell transplantation: a pediatric blood and marrow transplant consortium study

“…30 Intravenous glutamine supplementation, usually added to standard TPN solution has been studied in adult stem cell transplant patients, although a benefit has not been seen in all studies. [31][32][33][34][35][36][37][38][39][40][41][42] Ziegler et al 42 randomized adult BMT patients to receive glutamine-supplemented or standard glutamine-free parenteral nutrition. They demonstrated a significant decrease in the incidence of clinical infection, positive cultures, hospital days, and improvement in nitrogen balance in the patients who received glutamine supplements.…”