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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

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Abstract

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.

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Acknowledgments

We thank the medical staff of the participating centers for their approval and Nienke Janssen, Laura Reijm, Manon van Alphen, Marjan Laven, and Annemiek Botter for the assistance with the acquisition of data for this study.

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Authors and Affiliations

  1. Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Rianne van Lieshout, Debbie van der Lee, Anne R. Schaaphok & Merel Snellen

  2. Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Lidwine W. Tick

  3. Department of Research, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Jeanne P. Dieleman

  4. Department of Dietetics and Nutrition, Maastricht University Medical Center, Maastricht, The Netherlands

    Stephanie Custers

  5. Department of Dietetics and Nutrition, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Marieke S. van Dongen

  6. Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands

    Anne R. Schaaphok, Merel Snellen & Sandra Beijer

  7. Department of Internal Medicine, Section Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Harry C. Schouten

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  1. Rianne van Lieshout
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Contributions

R. van Lieshout contributed to the conception of the research. R. van Lieshout and S. Beijer contributed to the design of the research. R. van Lieshout, S. Beijer, S. Custers, M. Snellen, A.R. Schaaphok, and D. van der Lee contributed to the acquisition of the data. Statistical analysis of the data was performed by R. van Lieshout. R. van Lieshout, S. Beijer, J.P. Dieleman, L.W. Tick, and H.C. Schouten contributed to the interpretation of the data. R. van Lieshout drafted the manuscript. All authors critically revised the manuscript for important intellectual content, agree to accept public responsibility for appropriate portions of the content, and read and approved the final version of the manuscript to be published and all subsequent versions.

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Correspondence to Rianne van Lieshout.

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van Lieshout, R., Tick, L.W., Dieleman, J.P. et al. 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. Support Care Cancer 28, 4381–4393 (2020). https://doi.org/10.1007/s00520-019-05251-9

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