Blood Res.  2019 Mar;54(1):23-30. 10.5045/br.2019.54.1.23.

Efficacy of parenteral glutamine supplementation in adult hematopoietic stem cell transplantation patients

  • 1Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 2College of Pharmacy, Seoul National University, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.


Hematopoietic stem cell transplantation (HSCT) patients need parenteral nutrition because of nausea, vomiting, and mucositis caused by conditioning regimens. The demand for glutamine increases during the HSCT period. We evaluated the effects of glutamine-containing parenteral nutrition on the clinical outcomes of HSCT patients.
In this retrospective analysis, we reviewed HSCT patients from Seoul National University from August 2013 to July 2017. Depending on their glutamine supplementation status, 91 patients were divided into 2 groups: glutamine group (N=44) and non-glutamine group (N=47). We analyzed the rate of weight change, infection (clinically/microbiologically documented), complications (duration of mucositis and neutropenia, acute graft versus host disease), and 100-days mortality in each group.
Regarding the clinical characteristics of the patients, there were no significant differences between the 2 groups except that there was a larger proportion of myeloablative conditioning regimen in the glutamine group (P=0.005). In the glutamine group, the average number of days of glutamine use, parenteral nutrition, and mucositis was 7.6±1.4, 14.6±9.9, and 13.3±9.5, respectively. Furthermore, multivariate analysis revealed odds ratios of 0.37 (95% CI, 0.14-0.96; P=0.042) and 0.08 (95% CI, 0.01-0.98; P=0.048) for clinically documented infection and 100-days mortality, respectively, in the glutamine group.
Results showed that the glutamine group had less clinically documented infection and 100-days mortality than the non-glutamine group, but the other outcomes did not show significant differences. The extended duration of glutamine supplementation according to the period of total parenteral nutrition and mucositis should be considered.


Glutamine; Hematopoietic stem cell transplantation; Parenteral nutrition

MeSH Terms

Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Multivariate Analysis
Odds Ratio
Parenteral Nutrition
Parenteral Nutrition, Total
Retrospective Studies


1. August DA, Huhmann MB. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr. 2009; 33:472–500.
2. Bozzetti F. Nutritional support of the oncology patient. Crit Rev Oncol Hematol. 2013; 87:172–200.
3. Bozzetti F, Arends J, Lundholm K, et al. ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clin Nutr. 2009; 28:445–454.
4. Newsholme P, Procopio J, Lima MM, Pithon-Curi TC, Curi R. Glutamine and glutamate-their central role in cell metabolism and function. Cell Biochem Funct. 2003; 21:1–9.
5. Kuhn KS, Muscaritoli M, Wischmeyer P, Stehle P. Glutamine as indispensable nutrient in oncology: experimental and clinical evidence. Eur J Nutr. 2010; 49:197–210.
6. Wang X, Pierre JF, Heneghan AF, Busch RA, Kudsk KA. Glutamine improves innate immunity and prevents bacterial enteroinvasion during parenteral nutrition. JPEN J Parenter Enteral Nutr. 2015; 39:688–697.
7. Castell LM, Bevan SJ, Calder P, Newsholme EA. The role of glutamine in the immune system and in intestinal function in catabolic states. Amino Acids. 1994; 7:231–243.
8. Park HJ. Role of parenteral glutamine in nutrition support for critically Ill patients. J Clin Nutr. 2015; 7:42–48.
9. Bacigalupo A, Ballen K, Rizzo D, et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant. 2009; 15:1628–1633.
10. Cordonnier C, Engelhard D, Ljungman P, et al. Definitions of infectious diseases and complications after stem cell transplant: A proposal from the Infectious Diseases Working Party of the EBMT. Leiden, The Netherlands: EBMT;2011. Accessed July 26, 2018. at
11. Vanek VW, Matarese LE, Robinson M, et al. A.S.P.E.N. position paper: parenteral nutrition glutamine supplementation. Nutr Clin Pract. 2011; 26:479–494.
12. Crowther M, Avenell A, Culligan DJ. Systematic review and meta-analyses of studies of glutamine supplementation in haematopoietic stem cell transplantation. Bone Marrow Transplant. 2009; 44:413–425.
13. Piccirillo N, De Matteis S, Laurenti L, et al. Glutamine-enriched parenteral nutrition after autologous peripheral blood stem cell transplantation: effects on immune reconstitution and mucositis. Haematologica. 2003; 88:192–200.
14. Kuskonmaz B, Yalcin S, Kucukbayrak O, et al. The effect of glutamine supplementation on hematopoietic stem cell transplant outcome in children: a case-control study. Pediatr Transplant. 2008; 12:47–51.
15. da Gama Torres HO, Vilela EG, da Cunha AS, et al. Efficacy of glutamine-supplemented parenteral nutrition on short-term survival following allo-SCT: a randomized study. Bone Marrow Transplant. 2008; 41:1021–1027.
16. Ziegler TR, Young LS, Benfell K, et al. Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Ann Intern Med. 1992; 116:821–828.
17. Pytlik R, Benes P, Patorkova M, et al. Standardized parenteral alanyl-glutamine dipeptide supplementation is not beneficial in autologous transplant patients: a randomized, double-blind, placebo controlled study. Bone Marrow Transplant. 2002; 30:953–961.
18. Murray SM, Pindoria S. Nutrition support for bone marrow transplant patients. Cochrane Database Syst Rev. 2009; CD002920.
Full Text Links
  • BR
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: