A H Herbers1, T Feuth2, J P Donnelly3, N M Blijlevens3. 1. Department of Haematology. Electronic address: A.Herbers@hemat.umcn.nl. 2. Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 3. Department of Haematology.
Abstract
BACKGROUND: Currently, objective tests are lacking that enable the extent and duration of intestinal mucosal damage induced by myeloablative chemotherapy to be determined. To address this problem, we explored a citrulline-based assessment score as this amino acid is a simple quantitative marker of intestinal failure. PATIENTS AND METHODS: From March 2004 to June 2007, citrulline concentrations were determined at baseline and at least once weekly after the start of myeloablative chemotherapy until 30 days thereafter among 94 allogeneic or autologous haematopoietic stem-cell transplant recipients. The patients were divided into three groups according to the regimen they received: (i) carmustine, etoposide, cytarabine and melphalan/high-dose melphalan, (ii) cyclophosphamide and total body irradiation +/- antithymocyte globulin and (iii) idarubicin-containing regimens. Intestinal mucosal damage was described either by level of citrulline on each day, on the basis of different thresholds of citrulline indicating the severity of villous atrophy, or by area under the curve using reciprocal value of 10/citrulline. RESULTS: Regimens that incorporated idarubicin induced the most severe intestinal toxicity. Scores based on the level of citrulline, using severity thresholds, and on the area under the reciprocal curve are able to discriminate between the damage induced by different high-dose chemotherapy regimens. CONCLUSION: A citrulline-based assessment score appears objective, validated, reproducible, reliable, specific and sensitive making it a suitable first choice for measuring and monitoring intestinal mucositis.
BACKGROUND: Currently, objective tests are lacking that enable the extent and duration of intestinal mucosal damage induced by myeloablative chemotherapy to be determined. To address this problem, we explored a citrulline-based assessment score as this amino acid is a simple quantitative marker of intestinal failure. PATIENTS AND METHODS: From March 2004 to June 2007, citrulline concentrations were determined at baseline and at least once weekly after the start of myeloablative chemotherapy until 30 days thereafter among 94 allogeneic or autologous haematopoietic stem-cell transplant recipients. The patients were divided into three groups according to the regimen they received: (i) carmustine, etoposide, cytarabine and melphalan/high-dose melphalan, (ii) cyclophosphamide and total body irradiation +/- antithymocyte globulin and (iii) idarubicin-containing regimens. Intestinal mucosal damage was described either by level of citrulline on each day, on the basis of different thresholds of citrulline indicating the severity of villous atrophy, or by area under the curve using reciprocal value of 10/citrulline. RESULTS: Regimens that incorporated idarubicin induced the most severe intestinal toxicity. Scores based on the level of citrulline, using severity thresholds, and on the area under the reciprocal curve are able to discriminate between the damage induced by different high-dose chemotherapy regimens. CONCLUSION: A citrulline-based assessment score appears objective, validated, reproducible, reliable, specific and sensitive making it a suitable first choice for measuring and monitoring intestinal mucositis.
Authors: Kerri B Gosselin; Henry A Feldman; Andrew L Sonis; Lori J Bechard; Mark D Kellogg; Kathleen Gura; Robert Venick; Catherine M Gordon; Eva C Guinan; Christopher Duggan Journal: J Pediatr Gastroenterol Nutr Date: 2014-06 Impact factor: 2.839
Authors: Walter J F M van der Velden; Alexandra H E Herbers; Ton Feuth; Nicolaas P M Schaap; J Peter Donnelly; Nicole M A Blijlevens Journal: PLoS One Date: 2010-12-20 Impact factor: 3.240
Authors: Karin G E Miedema; Eveline S J M de Bont; Rob F M Oude Elferink; Michel J van Vliet; Claudi S M Oude Nijhuis; Willem A Kamps; Wim J E Tissing Journal: Support Care Cancer Date: 2010-08-28 Impact factor: 3.603
Authors: Samuel Vokurka; Tomas Svoboda; Daniel Rajdl; Terezie Sedláčková; Jaroslav Racek; Vladimir Koza; Ladislav Trefil Journal: Med Sci Monit Date: 2013-02-01
Authors: Tomoki Yoneyama; Kojo Abdul-Hadi; Adam Brown; Emily Guan; Matt Wagoner; Andy Z X Zhu Journal: CPT Pharmacometrics Syst Pharmacol Date: 2019-11-12