Abstract
Total parenteral nutrition (TPN) is provided to patients undergoing allogenic hematologic stem cell transplantation (allo-HSCT) to help minimize nutritional consequences of both conditioning regimens as well as complications resulting from the procedure such as GVHD, VOD and so on, and glutamine could to improve the clinical course of patients after transplantation while given with parenteral nutrition as it is considered that it has stimulatory effects on lymphocytes and mucosa cells in vitro. In the study, we investigated the effect of dipeptiven, N(2)-L-Alanyl-L-Glutamine, which has dipeptides as free glutamine is rather unstable and poorly soluble, added to standard TPN preparations on complication and recovery of patients with allo-HSCT. 40 patients who suffered hematologic malignancies and received allo-HSCT were randomly assigned to receive either standard TPN (control group, n=20), or dipeptiven supplemented TPN (DPT group, n=20). The Bu/Cy2 regimen was used in conditioning with Bu (16mg/kg) plus Cy (120mg/kg) and all patients were given mycophenolate mofetil, CsA and MTX to prevent GVHD. The nutritiona support was started about 1 to 12 days after transplantation and 1.5ml/kg.d dipeptiven was added to the DPT group. During the period of nutritiona support, serum albumin, total protein, creatinine, total bilirubin, leukocytes, lymphocytes were monitored, and time to neutrophil engraftment, decrease of body weight, hospital stays, and other data related to hospital infection and acute GVHD were evaluated for all patients. As a result, the levels of serum albumin fell in the two groups on the 7-day, but on the 28-day those in the DPT group returned to normal and were significantly better than those in the control group (P<0.05). The total bilirubin and creatinine concentration did not change much. And lymphocytes of the patients in the DPT group recovered more rapidly than in the control group (P<0.05). There were less cases with clinical infection and microbial colonization in the DPT group than the control group (10 vs 16,11 vs 17, P<0.05). Also days for antibiotic requirements, days of diarrhea, changes of body weight and hospital stays reduced in the DPT group (16.5±10.6d vs 25.4±16.3d, 4.7±4.5d vs 8.2±6.0d, 2.0±2.0kg vs 3.3±1.6kg, 49.2±18.8d vs 58.0±20.2d, P<0.05, respectively). There were no different between the two groups of incidence of acute GVHD. In the conclusion, DPT-supplemented parenteral nutrition was beneficial in allo-HSCT patients for the nutritional status improving, the incidence of infection and damage of intestine, liver diminishing were all reduced, and the incidence of acute GVHD not increasing.
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