Background and objective: Cytostatic therapy often causes severe mucous toxicity with possible nutritional deterioration of patients. Clinical signs of intestinal toxicity and D-xylose absorption were studied in a controlled, randomised, double-blind trial of parenteral glutamine supplementation of autologous peripheral stem cell transplant patients. Methods: 40 consecutive patients (15 men, 25 women, median age 47.5 years) with haematological malignancies (32 pts.), solid cancer (4 pts.) and multiple sclerosis (4 pts.) were treated from 1999 to 2001 by high-dose chemotherapy (regimens: BEAM – 19 pts., HD-Melphalan 11 pts., HD-ICE 4 pts., HD-cyclophosphamide 2 pts., melphalan-mithoxathron 2 pts., busulphan-etoposide 1 pt., etoposide + TBI 1 pt.) with autologous stem cell transplant. Patients were randomly assigned either for parenteral administration of 30 g of alanyl-glutamine dipeptide (Dipeptiven, Fresenius-Kabi) or isonitrogenous glutamine-free amino acid solution from day +1 to day +14 or up to discharge from hospital. The serum xylose test (Eberts modification) was performed on admission, on day 0, +7, +14 and +28. Diarrhoea was evaluated daily. Results: A significant impairment of intestinal xylose absorption from day 0 (p = 0,02) with a peak between day +7 (p = 0,001) and day +14 (p = 0,004) with further normalisation to baseline values on day +28 was found. Administration of glutamine did not significantly change neither the time trend nor the severity of D-xylose malabsorption, it decreased insignificantly the number of days with diarrhoea but decreased significantly the intensity of diarrhoea: 8.7 ± 11.1 episodes vs. 19.1 ± 17.6 episodes in the control group (p = 0.035). No difference in D-xylose absorption, number of days or intensity of diarrhoea was found between different chemotherapeutic regimens. No statistical correlation of relative deterioration of D-xylose resorption on day +7 and diarrhoea after day 0 was found. Conclusions: Intestinal resorption is compromised by cytostatic therapy for at least 2 weeks from the day of ASCT. No difference between particular chemotherapy regimens can be detected by the serum D-xylose test. The mode and dosage of glutamine administration used in our study does not improve the resorptive capacity of intestine.

        Key words: ASCT – transplantation – chemotherapy – xylose test – diarrhoea – glutamine