Effects of N(2)-L-alanyl-L-glutamine on Intestine in Children Underwent Hematopoietic Stem Cell Transplantation.

Abstract

Objective To investigate effects of N(2)-L-alanyl-L-glutamine(dipeptide grutamine; dipeptiven, DPT)on complications and recovery of pediatric patients with hematopoietic stem cell transplantation(HSCT). Methods From March 2004 to November 2007, 56 pediatric patients with hematopoietic stem cell transplantation were assigned to receive either N(2)-L-alanyl-L-glutamine supplemented total parenteral nutrition (TPN) (DPT group, n=28) or standard total parenteral nutrition (control group, n=28) by means of stratified sampling of disease classification. The patients in DPT group received total parenteral nutrition enriched by 1.5 mL/(kg·d)N(2)-L-alanyl-L-glutamine injected for 21 days, and control group received glutamine-free total parenteral nutrition. Clinical chemistry index, blood cell count, body weight, complication and recovery of patients with hematopoietic stem cell transplantation were monitored and evaluated in all patients before and after total parenteral nutrition. Results 12 patients of DPT group and 26 patients of control group developed infantile diarrhea (P 0.05). Two patients of DPT group and ten cases of control group developed long term fever(≥14 days) (P 0.05). There were no significant difference between two groups in bacterial and fungi culture positive patients (P>0.05). Time length of antibiotic requirements and free-germ ward stay were shortened in DPT group [(20.0±7.1) d vs. (25.4±6.4) d, (20.2±6.7) d vs. (24.1±6.9) d; P 0.5×109/L neutrophils and the time to reach >20×109/L platelets(PLT)were (15.3±5.1) d, (29.0±14.4) d in DPT group and (16.2±5.8) d, (32.5±18.6) d in control group (P>0.05). There were 22 patients in DPT group and 21 patients in control group were successfully engrafted (P>0.05). There were 3, 0 patients in DPT group and 5, 1 patients in control group developed acute intestinal graft versus host disease(aGVHD), veno-occlusive disease (P>0.05). No significant difference were found in clinical chemistry index and blood cell count between two groups (P>0.05). Loss of body weight in DPT group was less than that of control group after hematopoietic stem cell transplantation (P<0.05). Conclusion There is no difference in the time to neutrophil engraftment between two groups. Pediatric patients with hematopoietic stem cell transplantation will benefit from N(2)-L-alanyl-L-glutamine-supplemented total parenteral nutrition for the nutritional status improving, diminishing the incidence of mucositis, infantile diarrhea and long term fever, reducing the time of fever, free-ward stay and antibiotic requirements, and the incidence of acute intestinal graft versus host disease not increased. Key words: glutamine(Gln); hematopoietic stem cell transplantation(HSCT); child