ONC: Hematological Malignancies (HCT): Use of Oral Glutamine 2008
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
ONC: HCT: Use of oral glutamine
Use of oral glutamine to decrease incidence or severity of mucositis or to support recovery following hematopoietic cell transplantation for hematologic malignancies is not currently recommended. Glutamine supplementation did not show an effect on the incidence or severity of oral mucositis, diarrhea, oral intake or PN requirements among patients with hematologic malignancies receiving autologous or allogeneic HCT.
Risks/Harms of Implementing This Recommendation
No potential risks or harms are associated with this recommendation.
Conditions of Application
No conditions limit the application of this recommendation.
Potential Costs Associated with Application
No obvious costs are associated with this recommendation.
- One positive quality RCT (Coghlin Dickson et al, 2000) and one neutral quality RCT (Jebb et al, 1995) found that 16-30 g glutamine per day orally did not result in significant differences in incidence or severity of oral mucositis or diarrhea; oral intake or PN requirements; need for pain medications; incidence of infectious complications; LOS or survival compared to placebo among patients with hematologic malignancies receiving autologous or allogeneic HCT.
- The timing, dosage and method of administration of the oral glutamine and placebo differed for the two studies.
- Further trials are needed.
Recommendation Strength Rationale
Based on two RCTs (one positive quality, one negative quality), conclusion statements are Grade III.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Does the use of oral glutamine improve tolerance and support recovery from hematopoietic cell transplantation (HCT) among individuals with hematologic malignancies?
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?
Coghlin Dickson TMC, Wong RM, Negrin RS, Shizuru JA, Johnston LJ, Hu WW, Blume KG, Stockerl-Goldstein KE. Effect of oral glutamine supplementation during bone marrow transplantation. J Parenteral Enteral Nutr. 2000;24:61-66.
Jebb SA, Marcus R, Elia M. A pilot study of oral glutamine supplementation in patients receiving bone marrow transplants. Clinical Nutrition. 1995;14:162-165.