Nutrition support for bone marrow transplant patients

Area of Science:

• Oncology
• Gastroenterology
• Nutrition Science

Background:

• Bone marrow transplantation (BMT) treatments can cause malnutrition due to poor appetite, mucositis, and gastrointestinal failure.
• Parenteral nutrition (PN) is a common support but increases infection risk.
• Enteral nutrition (EN) and glutamine supplementation are alternatives, but their comparative efficacy is unclear.

Purpose of the Study:

• To determine the efficacy of enteral nutrition (EN) or parenteral nutrition (PN) for patients undergoing bone marrow transplantation.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing nutrition support methods in BMT patients.
• Searched Cochrane Library, MEDLINE, EMBASE, and CINAHL up to 2000.
• Extracted data on patient characteristics, adverse effects, neutropenia, body weight changes, graft-versus-host disease, and survival.

Main Results:

• Glutamine mouthwash reduced neutropenia duration (p=0.009).
• PN with glutamine decreased hospital stay (p=0.00004) and positive blood cultures (p=0.006) compared to standard PN.
• PN was associated with higher line infection rates than IV fluids (p=0.0002).
• No evaluable data existed to compare PN directly with EN.

Conclusions:

• The comparative effectiveness of EN versus PN in BMT patients remains unevaluated due to insufficient data.
• PN with glutamine shows promise for earlier hospital discharge and fewer infections than standard PN.
• PN with glutamine is recommended for patients with gastrointestinal failure unable to tolerate EN.