Lipid Use, Nutrition, and Colitis in Patients With Hematological Malignancies

Experimental and clinical data attribute multiple anti-inflammatory effects to a diet enriched in omega-3 PUFA containing oils, mainly FO. These effects are mediated by their active metabolites, the EPA- and DHA-derived eicosanoids, which antagonize the predominantly pro-inflammatory derivates of omega-6 PUFA origin. In cardiovascular disease these data are supported by several large-scale trials, but there also is growing evidence of beneficial effects of an omega-3 PUFA rich diet in GI conditions such as postoperative trauma and inflammatory bowel disease. AML patients with neutropenic colitis suffer from a condition which is pathophysiologically closely related to the studied diseases. It is therefore reasonable to raise the question whether this cohort would equally benefit from a novel nutritional regimen enriched in omega-3 PUFA.

The proposed pilot study will address the question of the clinical value of adding an omega-3 PUFA containing lipid emulsion to the TPN regimen as regards protection against colitis ≥ °3 (primary objective). A numerical cutoff will be provided to support the decision whether further investigation is warranted or the intervention is considered not promising.

Target accrual is n=35 patients receiving TPN. An interim analysis will be performed after n1=13 patients will be evaluable for the primary endpoint. The results of this interim analysis will determine whether continuation of the trial is of interest or the trial be stopped. The sample size has been calculated by the use of Simon's two-stage minimax design.

Inclusion criteria

• All of the following:

Subjects with a cyto- or histopathologically confirmed diagnosis of newly diagnosed:

• AML or
• biphenotypic acute leukemia with predominantly myeloid features undergoing myeloablative treatment analogous to AML or
• refractory anemia with excess of blasts (RAEB) or refractory anemia with excess of blasts in transformation (RAEB-t) with an IPSS score of >1.5 (appendix 10.8.) and

• ECOG performance status (PS) £2 (see appendix 10.2.) and
• Written informed consent

Exclusion criteria

One or more of the following:

• Contraindication to myeloablative chemotherapy, intravenous lipids, or TPN
• Previous or concomitant chronic inflammatory bowel disease, unspecified colitis or pancreatitis
• Impaired hepatic or renal function as defined by:

• ALAT and/or ASAT >3 x upper normal limit (UNL) and/or Bilirubin >3 x UNL unless increase is most likely caused by AML organ infiltration
• Serum creatinin >3 x UNL (after adequate hydration), unless increase is most likely caused by AML organ infiltration
• Other concurrent severe and/or uncontrolled medical condition