• Intervention
    Is there a relationship between the intake of glutamine to reduce symptoms and the reduction of symptoms associated with cancer pateints?
    • Conclusion
      There is no evidence available that directly supports or refutes that the use of oral, enteral or parenteral glutamine will reduce symptoms associated with cancer.
    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Does the use of oral glutamine improve tolerance and support recovery from hematopoietic cell transplantation (HCT) among individuals with hematologic malignancies?
    • Conclusion

      Two(2) RCTs (1 positive quality, 1 neutral quality) all found that 16-30g glutamine per day orally is not effective in preventing diarrhea, improving oral intake or decreasing PN requirements, decreasing the need for pain medications, decreasing incidence of infectious complications, decreasing LOS, or improving survival in patients with hematologic malignancies receiving autologous or allogeneic HCT. The timing, dosage and method of administration of the glutamine all varied in these studies. Further trials are needed to clarify the relationship.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is the use of oral glutamine to decrease incidence or severity of oral mucositis associated with hematopoietic cell transplantation (HCT) for patients with hematological malignancies?
    • Conclusion

      Two (2) RCTs (1 positive quality, 1 neutral quality) found that 16-30g glutamine per day orally is not effective in decreasing the incidence or severity of oral mucositis associated with autologous or allogeneic hematopoietic cell transplantation for patients with hematologic malignancies. The timing, dosage and method of administration of oral glutamine all varied in these studies. Further trials are needed to clarify the relationship.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the use of parenteral glutamine by patients to improve tolerance and support recovery from hematopoietic cell transplant (HCT) and the reduction of mucositis associated with treatment?
    • Conclusion

      One positive quality meta-analysis (3 studies with 103 patients) and one positive quality RCT reported no benefit of parenteral glutamine for the prevention/reduction in mucositis. One additional RCT found a statistically significant difference in peak mucositis scores, but not duration of mucosits, when comparing those who received parenteral glutamine with those who received placebo. All of the studies were limited by small sample size. The dosing, administration and timing of glutamine supplementation varied for the studies as well. Further studies are needed.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of parenteral glutamine to improve tolerance and support recovery from a patient undergoing hematopoietic cell transplant (HCT) and the reduction of diarrhea associated with treatment?
    • Conclusion

      One meta-analysis (positive quality), that included 3 studies with 103 patients, did not find parenteral glutamine to be effective in reducing diarrhea in HCT patients.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of oral glutamine to improve tolerance and support recovery from chemotherapy and the reduction of mucositis or stomatitis associated with treatment of cancer patients?
    • Conclusion

      Five strong studies did not find glutamine to be effective. One (1) metaanalysis (5 studies and 343 patients) and 4 RCTs (including one crossover design), all with + quality rating and adequate sample sizes, did not find oral glutamine to be effective in preventing or reducing chemotherapy-induced oral mucositis/stomatitis. It should be noted that the studies used varying glutamine doses and administration schedules and included various cancer sites, but were primarily completed in FU-based chemotherapy. A non-randomized, neutral quality trial, found oral glutamine to be effective, but this study is limited by small sample size and study design.

       

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of oral glutamine to improve tolerance and support recovery from chemotherapy and the reduction of diarrhea associated with treatment of cancer patients?
    • Conclusion

      Three (3) RCT’s (all + quality) found mixed results (one positive, two no difference) on the ability of oral glutamine to reduce chemotherapy induced diarrhea. All studies used FU-based chemotherapy, but varied in cancer sites, chemotherapy dosing and dosage and administration of oral glutamine. Further studies with consistent oral glutamine supplementation and greater heterogeneity of cancer sites need to be completed.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of parenteral glutamine to improve tolerance and support recovery from chemotherapy and the reduction of mucositis associated with treatment in cancer pateints?
    • Conclusion

      Two studies had conflicting results on the benefit of parenteral glutamine for chemotherapy-induced mucositis/stomatitis. Both of these studies were limited by small sample size, one with poor study design, and differing glutamine dosing and administration. Larger studies with better study design are needed.



       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of oral glutamine to improve tolerance and support recovery from radiation therapy and the reduction of diarrhea associated with treatment of cancer patients?
    • Conclusion

      Oral glutamine is not effective in the prevention of radiation-induced diarrhea as found in one study, with adequate sample size and good study design. More studies are needed to clarify this relationship.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of oral glutamine to improve and support recovery from radiation therapy and the reduction of mucositis associated with treatment of cancer patients?
    • Conclusion

      There is no evidence available that directly supports or refutes that the use of oral glutamine can improve and support recovery from radiation therapy or can reduce mucositis associated with radiation therapy.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005