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Post-Transplant Events

Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT

Bone Marrow Transplantation volume 48, pages 1117–1122 (2013)Cite this article

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Abstract

Parenteral nutrition (PN) exacerbates hyperglycemia, which is associated with increased morbidity and mortality in various cancer populations. By using a retrospective design, we examined incident hyperglycemia in PN and non-PN recipients and the associations with clinical events and 5-year survival in a cohort treated for myeloma with melphalan and auto-SCT (n=112). Clinical comparisons were made at admission, and ‘before’ and ‘after’ initiating PN to discern differences and temporality. Actual infusion times were used for PN patients; time frames based on mean PN infusion days were created for the non-PN recipients. Oral intake was lower ‘before’ in PN vs non-PN patients (P<0.001); however, no differences in mucositis, emesis, infections or transfusions were detected ‘before.’ Incident hyperglycemia (⩾7.0 mmol/L) was significant ‘after’ PN initiation, and PN recipients experienced delays in WBC (P<0.05) and platelet engraftment (P=0.009), and required significantly greater RBC (P=0.0014) and platelet (P=0.001) support ‘after’ than non-PN patients. Neutropenic fever and longer hospital stay were more frequent among PN vs non-PN recipients (P<0.001). Differences in 5-year mortality were not apparent. The findings fail to support clinical benefits of PN administration during auto-SCT for myeloma. Further study is needed to discern if hyperglycemia or feeding per se was deleterious in this patient population.

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Acknowledgements

Support for this study was provided by the National Cancer Institute, Cancer Education and Career Development Program #R25CA057699-18 and the American Cancer Society (#RSG-04-218-01-CCE).

Author contributions: PMS conceived and carried out the study, participated in the data collection and data analyses and drafted the manuscript. JMK assisted to coordinate the study and carried out data collection. DL performed the statistical analyses and drafted the paper. JM assisted with study implementation and critical revisions. CAB supervised the study, participated in its design and drafted the manuscript.

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Authors and Affiliations

  1. Institute for Health Policy and Research, University of Illinois at Chicago, Chicago, IL, USA

    P M Sheean & D Liu

  2. General Clinical Research Center, The University of Chicago Hospitals, Chicago, IL, USA

    J M Kilkus

  3. Department of Medicine, Rush University Medical Center, Section of Hematology, Chicago, IL, USA

    J Maciejewski

  4. Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA

    C A Braunschweig

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  1. P M Sheean
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Correspondence to P M Sheean.

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Sheean, P., Kilkus, J., Liu, D. et al. Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT. Bone Marrow Transplant 48, 1117–1122 (2013). https://doi.org/10.1038/bmt.2013.11

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