Glutamine-enriched nutrition does not reduce mucosal morbidity or complications after stem-cell transplantation for childhood malignancies

A prospective randomized study

Cornelio Uderzo, Paola Rebora, Emanuela Marrocco, Stefania Varotto, Francesca Cichello, Maurizio Bonetti, Natalia Maximova, Davide Zanon, Franca Fagioli, Francesca Nesi, Roberto Masetti, Attilio Rovelli, Roberto Rondelli, Maria Grazia Valsecchi, Simone Cesaro

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background. Intravenous glutamine-enriched solution seems to be effective in posttransplant period in decreasing the severity and duration of mucositis. The aim of this randomized study was to determine the benefit of glutamine supplementation both on mucosal morbidity and in posttransplant associated complications. Methods. Children undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) for malignant hematological diseases were randomly assigned to standard total parenteral nutrition (S-TPN) or glutamine-enriched (GE)-TPN solution consisting of 0.4 g/kg/day of l-alanine-glutamine dipeptide. This treatment started on the day of HSCT and ended when the patients could orally cover more than 50% of their daily energy requirements. The severity and the rate of post-HSCT mucositis were based on World Health Organization criteria. All the analyses were conducted on intention-to-treat principle. Results. One hundred twenty consecutive patients (83 men; median age, 8.1 years) were enrolled. The mean duration of treatment was 23.5 and 23 days in the two treatment arms. The mean calorie intake was 1538 kcal/d in the S-TPN group and 1512 kcal/d in GE-TPN group. All patients were well nourished before and after HSCT. Mucositis occurred in 91.4% and 91.7% of patients in S-TPN and GE-TPN arm, respectively (P=0.98). Odds ratio adjusted by type of HSCT was 0.98 (95% confidence interval, 0.26-2.63). Type and duration of analgesic treatment, clinical outcome (engraftment, graft versus host disease, early morbidity, and mortality, relapse rate up to 180 days post-HSCT) were not significantly different in the two treatment arms. Conclusion. GE-TPN solution does not affect mucositis and outcome in well-nourished HSCT allogeneic patients.

Original languageEnglish
Pages (from-to)1321-1325
Number of pages5
JournalTransplantation
Volume91
Issue number12
DOIs
Publication statusPublished - Jun 27 2011

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Hematopoietic Stem Cell Transplantation
Stem Cell Transplantation
Glutamine
Prospective Studies
Mucositis
Morbidity
Total Parenteral Nutrition
Neoplasms
Hematologic Diseases
Dipeptides
Graft vs Host Disease
Therapeutics
Alanine
Analgesics
Odds Ratio
Confidence Intervals
Recurrence
Mortality

Keywords

  • Childhood malignancies
  • Glutamine
  • Mucosal complications
  • Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Glutamine-enriched nutrition does not reduce mucosal morbidity or complications after stem-cell transplantation for childhood malignancies : A prospective randomized study. / Uderzo, Cornelio; Rebora, Paola; Marrocco, Emanuela; Varotto, Stefania; Cichello, Francesca; Bonetti, Maurizio; Maximova, Natalia; Zanon, Davide; Fagioli, Franca; Nesi, Francesca; Masetti, Roberto; Rovelli, Attilio; Rondelli, Roberto; Valsecchi, Maria Grazia; Cesaro, Simone.

In: Transplantation, Vol. 91, No. 12, 27.06.2011, p. 1321-1325.

Research output: Contribution to journalArticle

Uderzo, C, Rebora, P, Marrocco, E, Varotto, S, Cichello, F, Bonetti, M, Maximova, N, Zanon, D, Fagioli, F, Nesi, F, Masetti, R, Rovelli, A, Rondelli, R, Valsecchi, MG & Cesaro, S 2011, 'Glutamine-enriched nutrition does not reduce mucosal morbidity or complications after stem-cell transplantation for childhood malignancies: A prospective randomized study', Transplantation, vol. 91, no. 12, pp. 1321-1325. https://doi.org/10.1097/TP.0b013e31821ab959
Uderzo, Cornelio ; Rebora, Paola ; Marrocco, Emanuela ; Varotto, Stefania ; Cichello, Francesca ; Bonetti, Maurizio ; Maximova, Natalia ; Zanon, Davide ; Fagioli, Franca ; Nesi, Francesca ; Masetti, Roberto ; Rovelli, Attilio ; Rondelli, Roberto ; Valsecchi, Maria Grazia ; Cesaro, Simone. / Glutamine-enriched nutrition does not reduce mucosal morbidity or complications after stem-cell transplantation for childhood malignancies : A prospective randomized study. In: Transplantation. 2011 ; Vol. 91, No. 12. pp. 1321-1325.
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T1 - Glutamine-enriched nutrition does not reduce mucosal morbidity or complications after stem-cell transplantation for childhood malignancies

T2 - A prospective randomized study

AU - Uderzo, Cornelio

AU - Rebora, Paola

AU - Marrocco, Emanuela

AU - Varotto, Stefania

AU - Cichello, Francesca

AU - Bonetti, Maurizio

AU - Maximova, Natalia

AU - Zanon, Davide

AU - Fagioli, Franca

AU - Nesi, Francesca

AU - Masetti, Roberto

AU - Rovelli, Attilio

AU - Rondelli, Roberto

AU - Valsecchi, Maria Grazia

AU - Cesaro, Simone

PY - 2011/6/27

Y1 - 2011/6/27

N2 - Background. Intravenous glutamine-enriched solution seems to be effective in posttransplant period in decreasing the severity and duration of mucositis. The aim of this randomized study was to determine the benefit of glutamine supplementation both on mucosal morbidity and in posttransplant associated complications. Methods. Children undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) for malignant hematological diseases were randomly assigned to standard total parenteral nutrition (S-TPN) or glutamine-enriched (GE)-TPN solution consisting of 0.4 g/kg/day of l-alanine-glutamine dipeptide. This treatment started on the day of HSCT and ended when the patients could orally cover more than 50% of their daily energy requirements. The severity and the rate of post-HSCT mucositis were based on World Health Organization criteria. All the analyses were conducted on intention-to-treat principle. Results. One hundred twenty consecutive patients (83 men; median age, 8.1 years) were enrolled. The mean duration of treatment was 23.5 and 23 days in the two treatment arms. The mean calorie intake was 1538 kcal/d in the S-TPN group and 1512 kcal/d in GE-TPN group. All patients were well nourished before and after HSCT. Mucositis occurred in 91.4% and 91.7% of patients in S-TPN and GE-TPN arm, respectively (P=0.98). Odds ratio adjusted by type of HSCT was 0.98 (95% confidence interval, 0.26-2.63). Type and duration of analgesic treatment, clinical outcome (engraftment, graft versus host disease, early morbidity, and mortality, relapse rate up to 180 days post-HSCT) were not significantly different in the two treatment arms. Conclusion. GE-TPN solution does not affect mucositis and outcome in well-nourished HSCT allogeneic patients.

AB - Background. Intravenous glutamine-enriched solution seems to be effective in posttransplant period in decreasing the severity and duration of mucositis. The aim of this randomized study was to determine the benefit of glutamine supplementation both on mucosal morbidity and in posttransplant associated complications. Methods. Children undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) for malignant hematological diseases were randomly assigned to standard total parenteral nutrition (S-TPN) or glutamine-enriched (GE)-TPN solution consisting of 0.4 g/kg/day of l-alanine-glutamine dipeptide. This treatment started on the day of HSCT and ended when the patients could orally cover more than 50% of their daily energy requirements. The severity and the rate of post-HSCT mucositis were based on World Health Organization criteria. All the analyses were conducted on intention-to-treat principle. Results. One hundred twenty consecutive patients (83 men; median age, 8.1 years) were enrolled. The mean duration of treatment was 23.5 and 23 days in the two treatment arms. The mean calorie intake was 1538 kcal/d in the S-TPN group and 1512 kcal/d in GE-TPN group. All patients were well nourished before and after HSCT. Mucositis occurred in 91.4% and 91.7% of patients in S-TPN and GE-TPN arm, respectively (P=0.98). Odds ratio adjusted by type of HSCT was 0.98 (95% confidence interval, 0.26-2.63). Type and duration of analgesic treatment, clinical outcome (engraftment, graft versus host disease, early morbidity, and mortality, relapse rate up to 180 days post-HSCT) were not significantly different in the two treatment arms. Conclusion. GE-TPN solution does not affect mucositis and outcome in well-nourished HSCT allogeneic patients.

KW - Childhood malignancies

KW - Glutamine

KW - Mucosal complications

KW - Transplantation

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