Nutrition support for bone marrow transplant patients

Area of Science:

• Oncology
• Gastroenterology
• Nutrition Science

Background:

• Bone marrow transplantation (BMT) patients face malnutrition due to chemotherapy side effects like poor appetite and gastrointestinal failure.
• Parenteral nutrition (PN) is a common support but carries infection risks.
• Enteral nutrition (EN) and substrate supplementation are alternatives.

Purpose of the Study:

• To evaluate the efficacy of enteral nutrition (EN) or parenteral nutrition (PN) in supporting 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) identified through comprehensive database searches (Cochrane Library, MEDLINE, EMBASE, CINAHL).
• Studies compared different nutrition support methods (EN, PN, IV hydration, oral diet) or placebo/control.
• Data collected included patient characteristics, adverse events, neutropenia, body weight changes, graft-versus-host disease, and survival.

Main Results:

• Glutamine mouthwash reduced neutropenia duration in two studies.
• Initial findings suggested PN with glutamine reduced hospital stay and positive blood cultures, but an updated study indicated potential increased hospital stay.
• PN was associated with a higher incidence of line infections compared to IV hydration; no definitive comparison between PN and EN was possible.

Conclusions:

• The benefit of PN with glutamine for reducing hospital stay is no longer definite.
• PN with glutamine may reduce positive blood cultures compared to standard PN.
• Intravenous fluids and oral diets are preferred over PN; however, PN with glutamine can be considered for severe gastrointestinal failure after EN trials.