Abstract
Background/Objective:
The study was conducted to determine if enteral glutamine, 0.65 g kg−1 daily for 7 days, is effective in reducing the incidence and severity of mucositis in paediatric oncology patients when given alongside chemotherapy. The study was carried out at St James's University Hospital, Leeds, UK.
Subjects/Methods:
This was a randomized study using the patients as their own controls. Seventy-six patients undergoing treatment for paediatric malignancy having at least two identical courses of chemotherapy and at risk of developing mucositis participated in the study. Patients received one course of chemotherapy with glutamine and an identical course without. Alternate patients were allocated to have glutamine with course 1 or with course 2. The severity of symptoms of mucositis and the duration of enteral and parenteral nutrition were recorded. Daily ammonia levels were measured.
Results:
Fifty patients completed the study. No statistical significance with regard to symptoms of mucositis was found. Fewer children receiving glutamine required parenteral nutrition (P=0.049), and the duration of parenteral nutrition was less (P=0.023). No adverse effects attributed to taking the glutamine were observed.
Conclusions:
The study showed that high-dose enteral glutamine did not reduce the incidence and severity of oral mucositis as determined by subjective toxicity measurements, but did show a significant reduction in parenteral nutrition usage. No adverse cumulative effect of this oral glutamine dose was observed.
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Acknowledgements
We are grateful to SHS International for providing the L-glutamine.
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Guarantors: SV Picton and E Ward.
Contributors: EW initiated this study. The study design was developed in discussions involving EW, MS, MH, VA, IL, SK and SVP. EW, MS and UR conducted the study. Data analysis was done by EW and DB. All investigators except VA were involved in discussions on data interpretation. The paper was written by EW and SVP with contribution from MH.
Appendices
Appendix A
Appendix B
Limited data were obtained from 19 of the 26 patients who failed to complete the study. Seven patients despite consenting to the study were complete non-starters and hence no data were obtained. The tables below give the results, however, as the data were not comparable, no statistics were done.
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Ward, E., Smith, M., Henderson, M. et al. The effect of high-dose enteral glutamine on the incidence and severity of mucositis in paediatric oncology patients. Eur J Clin Nutr 63, 134–140 (2009). https://doi.org/10.1038/sj.ejcn.1602894
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DOI: https://doi.org/10.1038/sj.ejcn.1602894
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