Nutrition support for bone marrow transplant patients

Area of Science:

• Hematology
• Oncology
• Clinical Nutrition

Background:

• Bone marrow transplantation (BMT) can lead to malnutrition due to side effects like poor appetite and gastrointestinal failure.
• Parenteral nutrition (PN) is often used but carries an increased risk of infection.
• Enteral nutrition (EN) and substrate supplementation are alternative nutritional support strategies.

Purpose of the Study:

• To evaluate the efficacy of enteral nutrition (EN) or parenteral nutrition (PN) for patients undergoing bone marrow transplantation.
• To assess the impact of glutamine supplementation in PN on patient outcomes.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing different nutritional support methods or controls in BMT patients.
• Searches conducted in major databases (Cochrane Library, MEDLINE, EMBASE, CINAHL) up to June 2006.
• Data collected on patient characteristics, adverse events, neutropenia, body weight changes, graft-versus-host disease, and survival.

Main Results:

• Glutamine mouthwash showed a reduction in neutropenia duration in two studies.
• Initial findings suggested PN with glutamine reduced hospital stay, but an updated study indicated a potential increase.
• PN with glutamine was associated with a reduced incidence of positive blood cultures compared to standard PN, though updated data showed increased odds.
• PN was linked to a higher incidence of line infections compared to intravenous hydration.

Conclusions:

• The definite benefit of PN with glutamine for reducing hospital stay is no longer certain.
• While hospital stay may not be reduced, PN with glutamine may decrease positive blood culture incidence compared to standard PN.
• Intravenous fluids and oral diets are preferred over PN; however, PN with glutamine can be considered for severe gastrointestinal failure unresponsive to EN.