Total parenteral nutrition delays platelet engraftment in patients who undergo autologous hematopoietic stem cell transplantation.

OBJECTIVES: One of the major challenges in the post-transplant period is nutrition. In this prospective, non-randomized study, total parenteral nutrition (TPN) was given to 31 patients and partial parenteral nutrition (PPN) was given to 30 patients undergoing autologous hematopoietic stem cell transplantation for solid tumors or hematologic malignancies to compare the effects of these parenteral nutrition modalities on post-transplant hematological engraftment, blood chemistry, and supportive therapy requirements. METHODS: All patients in the TPN group and 17 patients in the PPN group received growth factor in the post-transplant period. Both groups did not differ with respect to sex, age, and reinfused CD34(+) cell numbers. RESULTS: After transplantation body mass index and body weight decreased significantly in both groups (P < 0.001). Whereas serum albumin concentrations did not decrease significantly in the TPN group, it fell markedly in the PPN group at the end of parenteral nutrition (P = 0.019). After parenteral nutrition, blood chemistry was also remarkable for serum urea and glucose levels, which were elevated significantly in the TPN group (P < 0.001 and P = 0.03, respectively). Patients receiving TPN had a higher incidence of positive microbial cultures and clinical infection than did patients receiving PPN (64.5% versus 40%, P = 0.05). The most striking result was a delay in platelet engraftment for the TPN group compared with the PPN group (15.54 and 12.93 d, respectively; P = 0.014). This difference was also noted in patients using growth factor in the PPN group (P = 0.017). Parallel to these results, platelet transfusion requirement increased in the TPN group compared with the PPN group (1.93 versus 1.16 U, P = 0.004). Both groups were unremarkable for leukocyte recovery and red blood cell transfusion requirement. CONCLUSIONS: Consequently, TPN has some pitfalls of hyperglycemia, infection tendency, delayed platelet engraftment, and increased platelet transfusion requirement. Therefore, it should not be used as a standard nutrition support for patients undergoing autotransplantation.

Lack of platelet aggregation abnormality in Hodgkin's disease.

A high risk of venous thromboembolism or an increased bleeding tendency has been reported in patients with clinically diagnosed or occult cancer. That is why, in this study, the presence of platelet dysfunction in patients with newly diagnosed Hodgkin's disease was investigated. Platelet aggregation studies were performed in 31 patients with a mean age of 27.53+/-2.75 years and in 31 healthy volunteers with a mean age of 24.37+/-3.21 years. None of the patients had a history or a finding of bleeding diathesis or thromboembolism. A Lumi-Dual platelet aggregometer (Chrono-Log Corporation, Model 450) was used for platelet aggregation in platelet-rich plasma. Platelet aggregation responses were evaluated with ADP, collagen, epinephrine, and ristocetin. No significant difference could be found when compared with the results of healthy volunteers. In five of the patients, a primary, but not a secondary, response to ADP (2 microg/ml) was obtained (p < 0.02). Platelet dysfunction was not found in patients with newly diagnosed Hodgkin's disease in this study. One of the various pathogenic mechanisms of tumour-related thrombosis or haemorrhagic diathesis may play a role in oncological patients; for this reason, each patient should be investigated individually.

Spironolactone: is it a novel drug for the prevention of amphotericin B-related hypokalemia in cancer patients?

OBJECTIVE: Nephrotoxicity is the major adverse effect of amphotericin B (AmB), often limiting administration of full dosage. Selective distal tubular epithelial toxicity seems to be responsible for the profound potassium wasting that is a major clinical side effect of treatment with AmB. Potassium depletion also potentiates the tubular toxicity of AmB. This study was designed to assess the ability of spironolactone to reduce potassium requirements and to prevent hypokalemia in neutropenic patients on AmB treatment. METHODS: In this study 26 patients with various hematological disorders were randomized to receive either intravenous AmB alone or AmB and oral spironolactone 100 mg twice daily when developing a proven or suspected fungal infection. RESULTS: Patients receiving concomitant AmB and spironolactone had significantly higher plasma potassium levels than those receiving AmB alone (P = 0.0027). Those patients receiving AmB and spironolactone required significantly less potassium supplementation to maintain their plasma potassium within the normal range (P = 0.022). Moreover, urinary potassium losses were significantly less in patients receiving AmB and spironolactone than those receiving AmB alone (P = 0.040). CONCLUSION: This study showed that spironolactone can reduce potassium requirements and prevent hypokalemia by reducing urinary potassium loss in neutropenic patients on AmB treatment.