Ward, E., Smith, M., Henderson, M., Reid, U., Lewis, I., Kinsey, S., et al. (2009). The effect of high-dose enteral glutamine on the incidence and severity of mucositis in paediatric oncology patients. European Journal of Clinical Nutrition, 63(1), 134-140.

To determine if 0.65 g/kg enteral glutamine daily for 7 days is effective in reducing the incidence and severity of mucositis in pediatric oncology patients when given with chemotherapy

Patients received one course of chemotherapy with glutamine and an identical course without. Alternate patients were given glutamine with course 1 or with course 2.

• The study was comprised of 76 patients, aged 1–21 years.
• The sample was 56% male and 44% female.
• Cancer diagnoses were acute myelogenous leukemia (AML), B-cell non-Hodgkin lymphoma (NHL), Ewing’s sarcoma/primitive neuroectodermal tumor (PNET), rhabdomyosarcoma, osteosarcoma, and other.

The study was conducted at a single site at Yorkshire Regional Centre for Pediatric Oncology and Hematology in the United Kingdom.

Patients were undergoing the active treatment phase of care.

This was a randomized study using the patients as their own controls.

• Patient/parent diaries were used from day 1-21 using Common Toxicity Criteria for nausea, vomiting, diarrhea, oral mucositis, and abdominal pain.   
• Plasma ammonia and glutamine levels were recorded.
• Clinical measurements of weight, height, percentage weight/height, mid-upper arm circumference, total parenteral nutrition (TPN) use, enteral feeding, and other complicatios that could affect eating tolerance during enteral feeding.

No difference was found between the five symptoms or for the total number of children with each symptom.

Oral glutamine did not improve the nutritional status of patients in the study. Even though subjective toxicity scores showed more problems if glutamine was not used, because of the small sample size, the difference was not significant. In addition, 62% took glutamine via enteral feeding tube, therefore eliminating the local effect on the oral mucosa.

• The sample size was small with fewer than 100 patients.
• The study lacked a placebo.
• A number of patients were unable to complete the study.
• Randomizing all potential patients was not possible because of the need to urgently start treatment for some patients.

Further study into what factors resulted in the decreased use of TPN could be of benefit. Further studies are needed to investigate the use of oral glutamine using larger and more diverse populations.