Efficacy of Enteral Supplementation Enriched with Glutamine, Fiber, and Oligosaccharide on Mucosal Injury following Hematopoietic Stem Cell Transplantation

Abstract

The combination of glutamine, fiber and oligosaccharides (GFO) is thought to be beneficial for alleviating gastrointestinal mucosal damage caused by chemotherapy. A commercial enteral supplementation product (GFO) enriched with these 3 components is available in Japan. We performed a retrospective study to test whether oral GFO decreased the severity of mucosal injury following hematopoietic stem cell transplantation (HSCT). Of 44 HSCT patients, 22 received GFO and 22 did not. Severity of diarrhea/mucositis, overall survival, weight loss, febrile illness/documented infection, intravenous hyperalimentation days/hospital days, engraftment, acute and chronic GVHD, and cumulative incidence of relapse were studied. Sex, age, performance status, diagnosis, disease status, and treatment variables were similar in both groups. There were fewer days of diarrhea grade 3-4 in patients receiving GFO than in those who did not (0.86 vs. 3.27 days); the same was true for days of mucositis grade 3-4 (3.86 vs. 6.00 days). Survival at day 100 was 100% in the GFO group, but only 77.3% for the patients not receiving GFO (p = 0.0091, log-rank test). Weight loss and the number of days of intravenous hyperalimentation were better in the GFO group (p < 0.001 and p = 0.0014, respectively). Although not significant, less gut bacterial translocation with Enterococcus species developed in the GFO group (p = 0.0728) than in the non-GFO group. Other outcomes were not affected. To the best of our knowledge, this is the first comparative clinical study of GFO supplementation to alleviate mucosal injury after allo-HSCT. We conclude that glutamine, fiber and oligosaccharide supplementation is an effective supportive therapy to decrease the severity of mucosal damage in HSCT.

Pilot study investigating the effect of enteral and parenteral nutrition on the gastrointestinal microbiome post‐allogeneic transplantation

“…In other patient groups, fibre-containing EN has a positive effect on SCFA production compared with a fibre-free formula (Schneider et al, 2006). Fibre supplementation (plus glutamine and probiotics) may reduce mortality in patients undergoing HPCT (Iyama et al, 2014). This is the first study to report a difference in the microbiota based on level of oral intake post-HPCT and while luminal SCFA levels were not measured, the group who tolerated greater oral intake had higher microbial diversity and SCFA-producing taxa, likely due to greater fibre consumption.…”

The Gut Microbiota and Hematopoietic Stem Cell Transplantation: Challenges and Potentials

“…Other dietary components, especially those derived from the family Brassicaceae, are metabolized by the gut microbiota to indole-containing moieties and have protective effects on the intestinal mucosa. A study demonstrated reduced Enterococcus translocation and reduced mortality in HSCT patients who were administered fiber, glutamine, and oligosaccharides [35]. A clinical study investigating the effect of resistant starch as prebiotic to induce buty­rate production by the microbiota for the prevention of acute GvHD is ongoing (www.clinicaltrials.gov: NCT02763033).…”

Glutamine and its use in selected oncology settings

“…Iyama et al concluded that GFO supplementation was an effective supportive therapy to decrease the severity of mucosal injury in HSCT. 38 In the systematic review by Van Zyl, 20 significant associations (RR 0.14, p = 0.05) were reported in two studies with adult patients (n = 45) in which fewer grade 3 or 4 mucositis cases were present when patients received IV-GLN vs placebo. Significant results for interventions >14 days (RR 0.19, p = 0.0003) were also obtained in four studies (n = 410) in which presence of grade 3 or 4 mucositis was significantly less in the IV-GLN group after 14 days of consecutive administration.…”

“…23 A possible trend in the objective reduction of mucositis by glutamine supplementation in non-BMT patients receiving chemotherapy and/or radiotherapy has been reported. 37 Furthermore, a Japanese study 38 using a combination of GLN, fibre and oligosaccharides (GFO) was the first retrospective comparative clinical study of mucosal injury in allogeneic HSCT using GFO. Iyama et al concluded that GFO supplementation was an effective supportive therapy to decrease the severity of mucosal injury in HSCT.…”