Pat Killingsworth Pat Killingsworth

Another supplement to avoid, especially before, during and immediately after a transplant: L-Glutamine

For every comment that shows-up on my site, I receive at least three or four emails.  Apparently, so does our new nutritional columnist, Danny Parker.

Danny emailed me this yesterday:

Pat,

Looks like we’ve opened a floodgate of questions. Goodness.

On the L-Glutamine issue, the basis of my qualified caution comes from the two studies below. The results from the first would suggest that L-Glutamine during high dose mephalan administration before a stem cell transplant is not a good idea. (see my emphasis in the abstract).

What we don’t know is what L-Glutamine might do after a stem cell transplant. No research on that.

The second study, from all the way  back to 1976, shows that available L-glutamine is important to culturing myeloma cell lines in the lab– not a reassuring fact:

http://jcs.biologists.org/content/21/3/609.full.pdf

And while I know L-Glutamine is helpful in cases of PN and gastric distress, given what I see in these two references give me pause in wanting to take it if I can do without it.

As always, however, it is a patient’s personal decision on things like this and I respect the tough dilemma under which we all struggle.

Danny

Thanks again for taking the time to enlighten us, Danny!   I think a star is born!  You will find one of the studies he references below.

Feel good and keep smiling!  Pat

The effect of glutamine on disease progression in multiple myeloma (MM) patients receiving high-dose melphalan
Crook J. L., Wasalenko J. K., Myhand R. C.–Walter Reed Army Medical Center, Washington, DC.
Biology Blood Marrow Transplant February 2003 € Volume 9 € Number 2

Mucositis, a frequent complication of high-dose therapy, is associated with major morbidity and mortality. Glutamine is one agent that has been shown to protect the gastro-intestinal epithelium from the toxic effects of chemotherapy. Although oral glutamine has been used successfully to prevent transplant related mucositis, the potential for glutamine mediated tumor protection has not been systematically investigated. In order to identify any possible tumor protective effect of glutamine in high-dose therapy, we performed a retrospective review of consecutive patients who received high-dose therapy with melphalan (200 mg/m2) for MM either with or without glutamine. Between July 1997 and August 2002, 41 patients were treated at our institution. The first 17 patients did not receive glutamine prophylaxis. In July 2000, we incorporated glutamine (10 gm po TID starting with the administration of the preparative regimen) standardly for mucositis prophylaxis. Twenty-four patients received glutamine. Eleven patients were lost to follow up (6 no glutamine, 5 glutamine). The response rate to transplant in the no glutamine group was 43%, compared with 47% in the glutamine group. In the no glutamine group, 8/11 patients (73%) were progression free at a median follow-up of 19 months, compared with 15/19 (79%) in the glutamine group at a median follow-up of only 9 months. Interestingly, of the patients who relapsed, the median time to relapse was 17 months in the no glutamine group and only 6 months in the glutamine group. Our observation is that glutamine at this dose may be associated with early relapse and poorer progression-free survival (PFS) in MM patients treated with high-dose melphalan. These data support the in vitro examination of glutamine in tumor cell lines to discern if glutamine abrogates the cytotoxic effects of chemotherapy. Future prospective trials should scrutinize response rates, PFS, and overall survival in glutamine and nonglutamine treated patients especially if higher-doses are utilized.

Here is the source link for the above:
http://myeloma.org/ArticlePage.action?articleId=880