Oral glutamine in the prevention of fluorouracil induced intestinal toxicity: a double blind, placebo controlled, randomised trial

Glutamine supplementation in bone marrow transplantation

An increasing number of clinical investigations have focused on supplementation of specialized enteral and parenteral nutrition with the amino acid glutamine. This interest derives from strong evidence in animal models and emerging clinical data on the efficacy of glutamine administration following chemotherapy, trauma, sepsis and other catabolic conditions. Glutamine has protein-anabolic effects in stressed patients and, among many key metabolic functions, is used as a major fuel/substrate by cells of the gastrointestinal epithelium and the immune system. These effects may be particularly advantageous in patients undergoing bone marrow transplantation (BMT), who exhibit post-transplant body protein wasting, gut mucosal injury and immunodeficiency. Studies to date indicate that enteral and parenteral glutamine supplementation is well tolerated and potentially efficacious after high-dose chemotherapy or BMT for cancer treatment. Although not all studies demonstrate benefits, sufficient positive data have been published to suggest that this nutrient should be considered as adjunctive metabolic support of some individuals undergoing marrow transplant. However, BMT is a rapidly evolving clinical procedure with regard to the conditioning and supportive protocols utilized. Thus, additional randomized, double-blind, controlled clinical trials are indicated to define the efficacy of glutamine with current BMT regimens.

Glutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy

Glutamine supplementation of enteral and parenteral nutrition support has received increased attention in the research community over the past decade. Glutamine may become a conditionally essential nutrient during certain catabolic states, including after bone marrow transplantation (BMT). The administration of enteral or parenteral glutamine seems safe and also potentially efficacious in some patient groups undergoing intensive treatment for cancer. Studies indicate that adjunctive glutamine treatment may improve nitrogen retention, decrease clinical infection and length of hospital stay and reduce the incidence and severity of mucositis after BMT and high dose chemotherapy. Although not all studies demonstrate benefit, there are sufficient positive data to suggest that this nutrient should be considered in the metabolic support of many individuals undergoing the catabolic process of marrow transplantation. Given the available data, randomized, double-blind, controlled clinical trials of glutamine-enriched nutrition in patients receiving BMT and high dose chemotherapy protocols are indicated to further define the utility of this amino acid as adjunctive therapy. Studies of glutamine nutrition combined with current combinations of cytoreductive agents and hematopoietic growth factors in BMT will be particularly pertinent.