Feasibility of Intermittent Fish Oil Infusions in Outpatients with Graft- Versus-Host Disease of the Digestive Tract

Barbara Van Der Meij

doi:10.4172/2155-9600.1000201

Abstract

N-3 polyunsaturated fatty acids from fish oil may have immune-modulating effects in Graft-versus-Host Disease of the digestive tract (GVHD-DT). The objective of this pilot study was to investigate feasibility, safety and effects on fatty acid composition of plasma lipids and white blood cells (WBC), following intermittent fish oil infusion in outpatients with chronic GVHD-DT. Four outpatients received intermittent infusion of a 10% fish oil emulsion (Omegaven) during 4 hours, at day 1 (1.5 mL/kg), 3 (2.25 mL/kg) and 5, 8, 10 and 12 (3 mL/kg). At baseline and consecutive visits, fatty acid composition of plasma triglycerides (TG), plasma phospholipids (PL) and WBC, serum TG concentrations, routine laboratory tests, as well as adverse events were monitored. During the fish oil infusions, serum TG increased, but decreased 2 h after termination of infusion. In 3 patients, the dose of Omegaven® needed to be reduced. EPA was incorporated into plasma PL, plasma TG and WBC as of 2 days after the first infusion; peak levels of EPA were reached at the final infusion, or 2 days after. In conclusion, intermittent fish oil infusions result in incorporation of EPA in plasma and WBC, but can be complicated by a reversible increase in serum triglycerides.

Highlights

Allogeneic haematopoietic stem cell transplantation is a commonly used modality in the treatment of haematological malignancies
This study was conducted as a pilot study in outpatients with chronic Graft-versus-Host Disease of the digestive tract (GVHD-DT), after reduced intensity conditioning stem cell transplantation (RIC) allo-SCT of a human leukocyte antigen (HLA) identical sibling
We screened 12 patients with Graft-versus-Host Disease (GVHD)-DT complaints after allo-RIC of an HLA-matched sibling; 4 of them deceased, 3 patients were not willing to participate, and 1 patient was not suffering from GVHDDT, but diagnosed with an oesophageal ulcer

Summary

Introduction

Allogeneic haematopoietic stem cell transplantation (allo-SCT) is a commonly used modality in the treatment of haematological malignancies. A significant, but rare complication of this treatment is Graft-versus-Host Disease (GVHD), when donor T cells mediate cytotoxic damage to host target organs, such as the skin, liver or digestive tract. The prevalence of GVHD is 30-40% after myeloablative allo-SCT, and at least 50% after reduced intensity conditioning stem cell transplantation (RIC) [1,2]. Two main categories of GVHD are recognized; acute and chronic GVHD [1]. Acute GVHD presents within the first 100 days after the conventional myeloablative allo-SCT, and chronic GVHD emerges 100 days or longer after allo-SCT. The distinction between chronic and acute GVHD after RIC appears to be less clear

Methods

Results

Conclusion