Changes in body weight and serum liver tests associated with parenteral nutrition compared with no parenteral nutrition in patients with acute myeloid leukemia during remission induction treatment

• Published in: Supportive care in cancer Vol. 28; no. 9; pp. 4381 - 4393
• Main Authors: van Lieshout, Rianne, Tick, Lidwine W., Dieleman, Jeanne P., Custers, Stephanie, van Dongen, Marieke S., van der Lee, Debbie, Schaaphok, Anne R., Snellen, Merel, Schouten, Harry C., Beijer, Sandra
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2020; Springer; Springer Nature B.V
• Subjects: Analysis; Bilirubin; Body weight; Cancer; Cancer therapies; Care and treatment; Evidence-based medicine; Leukemia; Liver; Medical records; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Nursing; Nursing Research; Nutrition; Oncology; Original Article; Pain Medicine; Parenteral nutrition; Rehabilitation Medicine; Remission (Medicine); Weight; Parenteral nutrition; Body weight loss; Acute myeloid leukemia; Remission induction treatment; Serum liver tests
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-019-05251-9

Purpose
Differences in body weight changes and serum liver tests (LTs) in acute myeloid leukemia (AML) patients receiving parenteral nutrition (PN) versus no PN during remission induction (RI) treatment were assessed.
Methods
Retrospectively, differences in body weight changes and serum LTs in AML patients (
n
 = 213) who received PN versus no PN during RI treatment in one of three Dutch hospitals between 2004 and 2015 were assessed. Weekly body weight and serum LT registrations were collected from medical records. Patients’ body weight changes were compared between the hospitals where PN is applied upon first indication of inadequate oral intake (PN hospitals) and the hospital where use of PN is limited to severe cases only (no-PN hospital) using repeated measures mixed model analysis. Differences in severity of serum LT elevations, according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, were assessed between patients who did and did not receive PN using chi-square or Fisher’s exact tests, and multiple logistic regression analysis.
Results
Compared with patients of the PN hospitals, patients of the no-PN hospital experienced significantly more body weight loss during RI treatment (between-group difference 7.2%, 95% CI 4.0–10.3%). Furthermore, PN was associated with transient mild to moderate elevations of liver enzymes, but not with raised median total bilirubin levels nor with occurrence of CTCAE grade 3–4 LT elevations.
Conclusion
Frequent compared with exceptional use of PN in AML patients during RI treatment better preserved body weight, without clinically relevant (CTCAE grade 3–4) elevations in serum LTs.