Blood Res 2019; 54(1): 23-30  https://doi.org/10.5045/br.2019.54.1.23
Efficacy of parenteral glutamine supplementation in adult hematopoietic stem cell transplantation patients
Yun Kyung Cho1, So Yeon Hong1, Su Jeoung Jeon1, Hyung Wook Namgung1, Eunsook Lee1, Euni Lee2, Soo-Mee Bang3
1Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 2College of Pharmacy, Seoul National University,
Seoul, 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Correspondence to: Soo-Mee Bang, M.D., Ph.D. Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil 82, Bundang-gu, Seongnam 13620, Korea E-mail: smbang7@snu.ac.kr
Received: June 17, 2018; Revised: August 21, 2018; Accepted: September 27, 2018; Published online: March 31, 2019.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
Hematopoietic stem cell transplantation (HSCT) patients need parenteral nutrition because of nausea, vomiting, and mucositis caused by conditioning regimens. The demand for glutamine increases during the HSCT period. We evaluated the effects of glutamine-containing parenteral nutrition on the clinical outcomes of HSCT patients.

Methods
In this retrospective analysis, we reviewed HSCT patients from Seoul National University from August 2013 to July 2017. Depending on their glutamine supplementation status, 91 patients were divided into 2 groups: glutamine group (N=44) and non-glutamine group (N=47). We analyzed the rate of weight change, infection (clinically/microbiologically documented), complications (duration of mucositis and neutropenia, acute graft versus host disease), and 100-days mortality in each group.

Results
Regarding the clinical characteristics of the patients, there were no significant differences between the 2 groups except that there was a larger proportion of myeloablative conditioning regimen in the glutamine group (P=0.005). In the glutamine group, the average number of days of glutamine use, parenteral nutrition, and mucositis was 7.6±1.4, 14.6±9.9, and 13.3±9.5, respectively. Furthermore, multivariate analysis revealed odds ratios of 0.37 (95% CI, 0.14‒0.96; P=0.042) and 0.08 (95% CI, 0.01‒0.98; P=0.048) for clinically documented infection and 100-days mortality, respectively, in the glutamine group.

Conclusion
Results showed that the glutamine group had less clinically documented infection and 100-days mortality than the non-glutamine group, but the other outcomes did not show significant differences. The extended duration of glutamine supplementation according to the period of total parenteral nutrition and mucositis should be considered.
Keywords: Glutamine, Hematopoietic stem cell transplantation, Parenteral nutrition


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