Oral Glutamine and Probiotics On Enteral Morbidity Following Autologous Stem Cell Transplantation for Plasma Cell Dyscrasias

The dose limiting toxicity of high dose melphalan conditioning for autologous stem cell transplantation (HDM-ASCT) in patients with plasma cell dyscrasias (PCD) is mucositis of the upper and lower gastrointestinal tract. Mucositis can lead to decreased oral intake, increased length of stay (LOS) and gut-derived infections. Studies with transplant recipients have shown conflicting results regarding the efficacy of the amino acid glutamine and the probiotic yeast Saccharomyces boulardii (GSB) for mucositis attenuation, improvement in gut immune barrier function, and modulation of inflammatory cytokines. We sought to evaluate the benefit of GSB on mucosal morbidity and incidence of diarrhea at our institution, where 151 patients with PCD were transplanted between January 2011 and July 2012.

            For this retrospective case control study, inclusion criteria were patients with multiple myeloma and AL amyloidosis who received HDM-ASCT either as consolidation of front-line therapy or salvage. At our institution, based on referring physician group preference, one group of patients with PCD was routinely prescribed GSB while another group was not. The 75 patients receiving supplementation were prescribed to take daily L-glutamine for 2 weeks, leaving a 4-day pause before the transplant date, and daily Saccharomyces boulardii for 2 weeks prior to the transplant, until the day of admission, with a cost of USD 83. The remaining 76 patients did not receive GSB. As per institutional standard of care, all subjects received cryotherapy during HDM infusion for prophylaxis of mucositis.

            The charts of the 151 patients (86 males, 65 females) aged 27 - 72 years (median 61 years) who received HDM-ASCT between January 2011 and July 2012 were reviewed. Incidence of mucositis in the GSB group was 30.7% vs 34.2% in the no GSB group. Severe mucositis, defined as preventing oral intake, occurred in 10.1% of the GSB group and 17.1% of the no GSB group. Incidence of diarrhea in the 2 groups was 86.7% and 81.6%, in the OGP group and no GSB group, respectively, with no difference in incidence of C. difficile-associated diarrhea.

            Administration of GSB was well tolerated and safe, and with no associated fungemia. The administration of GSB in the immediate pre-transplant period did not impact LOS, incidence and severity of mucositis, or incidence and volume of diarrhea. Complete analysis and subgroup analysis are being performed and will be presented at the meeting.