Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial autologous stem cell transplant

Parenteral nutrition (PN) exacerbates hyperglycemia, which is associated with increased morbidity and mortality in various cancer populations. Using a retrospective design, we examined incident hyperglycemia in PN and non-PN recipients and the associations with clinical events and 5-year survival in a cohort treated for myeloma with melphalan and auto-SCT (n=112). Clinical comparisons were made at admission, and “before” and “after” initiating PN to discern differences and temporality. Actual infusion times were used for PN patients; timeframes based on mean PN infusion days were created for the non-PN recipients. Oral intake was lower “before” in PN vs. non-PN patients (p=<0.001); however, no differences in mucositis, emesis, infections or transfusions were detected “before.” Incident hyperglycemia (≥7.0 mmol/L) was significant “after” PN initiation, and PN recipients experienced delays in WBC (p<0.05) and platelet engraftment (p= 0.009) and required significantly greater RBC (p=0.0014) and platelet (p=0.001) support “after” than non-PN patients. Neutropenic fever and longer hospital stay were more frequent among PN vs. non-PN recipients (p<0.001). Differences in 5-year mortality were not apparent. Findings fail to support clinical benefits of PN administration during auto-SCT for myeloma. Further study is needed to discern if hyperglycemia or feeding per se was deleterious in this patient population.