Oral and parenteral glutamine in bone marrow transplantation: A randomized, double-blind study

Background: Total parenteral nutrition (TPN) supplemented with glutamine (G LN) has been reported to be effective for patients with bone marrow transpl antation (BMT). Our aim was to evaluate enteral and parenteral glutamine in patients undergoing BMT. Methods: For evaluation of GLN in BMT, 66 patient s with 43 hematologic and 23 solid malignancies (21 breast carcinomas), wer e randomized, double-blinded, to either oral GLN (n = 35) or glycine-contro l (GLY) (n = 31), 10 g three times daily. When TPN became necessary, patien ts who received GLN orally were given TPN with GLN (0.57 g/kg). Those who r eceived GLY received standard TPN, isocaloric and isonitrogenous. Patients with hematologic malignancies received high-dose chemotherapy, total body i rradiation, and either allogeneic (ALLO) BMT (n = 18) or autologous (AUTO) stem cell transplantation (n = 25). Patients with solid malignancies (n = 2 3) received AUTO. Results: There were 14 in-hospital deaths without relatio nship to GLN administration. For respective comparisons of ALLO and AUTO tr ansplants in the GLN and GLY hematologic groups and AUTO in the solid tumor groups, there were no significant differences in hospital stay, duration o f stay after BMT, TPN days, neutrophil recovery >500/mm(3), incidence of po sitive blood cultures, sepsis, mucositis, and diarrhea. Acute graft us host disease occurred in 1 of 10 hematologic patients receiving GLN and in 3 of 8 patients receiving GLY placebo (p >.05). Possible reduction in need for TPN and a suggestion of improved long-term survival were associated with GL N. Conclusions: Oral and parenteral GLN seemed to be of limited benefit for patients having AUTO or ALLO BMT for hematologic or solid malignancies. Fu rther study of long-term effects of GLN in BMT seems warranted.