***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Total parenteral nutrition ( TPN ) supplemented with glutamine ( GLN ) has been reported to be effective for patients with bone marrow transplantation ( BMT ) . Our aim was to evaluate enteral and parenteral glutamine in patients undergoing BMT . METHODS For evaluation of GLN in BMT , 66 patients with 43 hematologic and 23 solid malignancies ( 21 breast carcinomas ) , were r and omized , double-blinded , to either oral GLN ( n = 35 ) or glycine-control ( GLY ) ( n = 31 ) , 10 g three times daily . When TPN became necessary , patients who received GLN orally were given TPN with GLN ( 0.57 g/kg ) . Those who received GLY received st and ard TPN , isocaloric and isonitrogenous . Patients with hematologic malignancies received high-dose chemotherapy , total body irradiation , and either allogeneic ( ALLO ) BMT ( n = 18 ) or autologous ( AUTO ) stem cell transplantation ( n = 25 ) . Patients with solid malignancies ( n = 23 ) received AUTO . RESULTS There were 14 in-hospital deaths without relationship to GLN administration . For respective comparisons of ALLO and AUTO transplants in the GLN and GLY hematologic groups and AUTO in the solid tumor groups , there were no significant differences in hospital stay , duration of stay after BMT , TPN days , neutrophil recovery > 500/mm3 , incidence of positive blood cultures , sepsis , mucositis , and diarrhea . Acute graft us host disease occurred in 1 of 10 hematologic patients receiving GLN and in 3 of 8 patients receiving GLY placebo ( p > .05 ) . Possible reduction in need for TPN and a suggestion of improved long-term survival were associated with GLN . CONCLUSIONS Oral and parenteral GLN seemed to be of limited benefit for patients having AUTO or ALLO BMT for hematologic or solid malignancies . Further study of long-term effects of GLN in BMT seems warranted Forty-four adult autologous transplant patients with hematological malignancies were r and omized to receive either prophylactic parenteral nutrition PN ( P group ) , or PN given ad hoc ( C group ) . In each group , they were further r and omized to receive st and ard PN ( B group ) , or PN with 0.5 g glutamine/kg as L-Ala-L-Gln ( A group ) . The overall survival ( OS ) , disease-free survival ( DFS ) and event-free survival ( EFS ) in groups C vs. P and A vs. B were compared during follow-up with median 38 months . The final outcome rates in C/P/A/B groups , respectively ( OS 65/81/63/85 % , EFS 45/53/33/65 % and DFS 56/50/35/77 % ) , were not significantly different , apart from A < B in DFS rate ( p=0.03 , Fisher 's exact test ) . Also in survival analysis ( logrank test ) , no significant difference between groups C and P was found but generally worse parameters were observed for A vs. B group : for DFS ( p=0.04 ) and EFS ( p=0.01 ) the difference was significant , and for OS ( p=0.09 ) it was borderline . In the three years ' follow-up , no clinical ly useful benefit of prophylactic PN in autologous transplant patients was proven . Also , glutamine supplementation was not helpful , and was even connected with apparently worse long-term outcome Objective : The purpose of this study was to determine the most appropriate dose of oral glutamine to use in a further clinical study in paediatric oncology patients . Design : This was a phase I , pharmokinetic study . Setting : The study was carried out at The Yorkshire Regional Centre for Paediatric Oncology and Haematology , St James 's University Hospital , Leeds , UK.Subjects : Thirteen patients undergoing treatment for paediatric malignancy participated in this study . All 13 completed the study . Interventions : The most appropriate dose was determined by patient acceptability and by plasma glutamine and ammonia levels measured at timed intervals after ingestion of a single glutamine dose . Results : Doses of 0.35 , 0.5 and 0.65 g/kg were well tolerated with no untoward plasma glutamine and ammonia levels . One patient was recruited to a higher dose of 0.75 g/kg , but the plasma glutamine and ammonia levels peaked at 2601 and 155 µmol/l , respectively . The ammonia level was greater than the acceptable upper limit . It was difficult to disperse the glutamine adequately at this dose , result ing in the suspension being found to be unpalatable and therefore no further patients were recruited at this dose . Conclusion : It was concluded that 0.65 g/kg is a safe dose of glutamine to use in a clinical study in paediatric oncology patients .Sponsorship : Scientific Hospital Supplies UK Ltd provided the L-glutamine and financial help for the biochemical analysis Painful oral mucositis is a common complication after  bone marrow transplantation ( BMT ) . Glutamine is a nutrient for rapidly dividing cells and the major energy source for intestinal epithelium . This study tested whether an oral glutamine preparation could decrease the severity of oral mucositis in patients undergoing BMT . Glutamine or a placebo ( glycine ) were administered from admission until day + 28 in 193 BMT patients in a r and omized , double-blind , placebo-controlled study at a dose of 1.0 g amino acid/m2/dose swish and swallow four times a day . In  autologous BMT patients ( n = 87 ) glutamine was associated with significantly less mouth pain by self report and by opiate use ( 5.0 ± 6.2 days of morphine for glutamine vs 10.3 ± 9.8 days for placebo ; P = 0.005 ) . Matched sibling BMT patients had no effect by self report and an increased duration of opiate use ( 23.2 ± 5.7 days for glutamine vs 16.3 ± 8.3 days for placebo ) ( P = 0.002 ) . However , day 28 survival of allogeneic patients was improved by glutamine . No significant differences in TPN use , rate of relapse or progression of malignancy , parenteral antibiotic use , acute or chronic GVHD , or days of hospitalization were observed in either autologous or allogeneic recipients . No toxicity of glutamine was observed . We conclude that oral glutamine can decrease the severity and duration of oropharyngeal mucositis in autologous BMT patients but not in allogeneic BMT patients , possibly due to interaction with methotrexate An oral glutamine load was administered to nine healthy subjects to determine the effect on plasma glutamine , bicarbonate , and circulating growth hormone concentrations .  Two grams glutamine were dissolved in a cola drink and ingested over a 20-min period 45 min after a light breakfast . Forearm venous blood sample s were obtained at zero time and at 30-min intervals for 90 min and compared with time controls obtained 1 wk earlier . Eight of nine subjects responded to the oral glutamine load with an increase in plasma glutamine at 30 and 60 min before returning to the control value at 90 min . Ninety minutes after the glutamine administration load both plasma bicarbonate concentration and circulating plasma growth hormone concentration were elevated . These findings demonstrate that a surprisingly small oral glutamine load is capable of elevating alkaline reserves as well as plasma growth hormone UNLABELLED Bone marrow transplantation ( BMT ) is a therapy used for hematologic malignancies and solid tumors . Associated chemotherapy and radiotherapy to which these patients are su bmi tted induce secondary effects , with a high metabolic stress . Glutamine is considered a conditionally essential amino acid , and has been shown effective in severe catabolic states . The aim of the study was to assess the effect of parenteral nutrition ( PN ) therapy supplemented with glutamine on duration of nutritional support in a group of patients with BMT .  We have also analyzed associated complications , the nutritional status , the clinical course at 6 months , differences as to type of transplantation , and oral ingestion capability . This is a phase IV , r and omized , double blind , and parallel clinical trial , done at a single center . The study was performed on 49 patients , 29 % male and 71 % female patients , with ages between 21 - 63 years , distributed in 3 diagnostic groups ( leukemia , lymphoma , and solid tumors ) , and admitted to the Hematology Department of our Hospital . Fifty percent of the patients in each group have received PN supplemented with glutamine ( 0.4 g/kg/day of L-alanine-L-glutamine ) , and the other 50 % have received st and ard PN . RESULTS we have not found significant differences nor at the beginning nor at the end of the study between both groups with regards to studied variables . CONCLUSIONS PN is and effective therapy for maintenance of the nutritional status in patients su bmi tted to a therapy with a , highly catabolic effect such as BMT . Although we have not been able to show the efficacy of glutamine supplementation in this study with the used dose , it does have been effective in other reports Glutamine ( Gln ) is an important nutrient substrate for lymphocytes and macrophages in vitro . This pilot study evaluated effects of Gln supplementation on circulating lymphocytes and lymphocyte subsets after allogeneic bone marrow transplantation ( BMT ) . Adult patients received either parenteral nutrition supplemented by L-Gln ( Gln-PN ) or st and ard Gln-free PN after BMT .  Leukocyte and total lymphocyte counts were determined during hospitalization , and flow cytometry studies of peripheral mononuclear cells were performed 1 to 2 weeks after hospital discharge . The  Gln-PN group demonstrated a higher percentage of blood lymphocytes during hospitalization . At flow cytometry , patients who received Gln-PN had an increased total lymphocyte count ( 332 + /- 50 versus 590 + /- 71 cells/microL , P = 0.010 ) ; greater numbers of total T lymphocytes ( 54 + /- 19 versus 229 + /- 70 cells/microL , P = 0.030 ) ; and higher CD4 + and CD8 + T-lymphocyte counts in peripheral blood compared with controls . Gln-PN may support lymphocyte recovery after BMT OBJECTIVE In a r and omized , double-blind , prospect i ve clinical trial , we evaluated the metabolic effects of glutamine-supplemented parenteral nutrition in patients with bone marrow transplants . We compared hospital charge and cost data for the two groups of patients in the trial . DESIGN Retrospective review . SETTING Bone Marrow Transplant Unit , Brigham and Women 's Hospital , Boston , Mass. SUBJECTS Forty-three patients admitted to the Bone Marrow Transplant Unit were assigned r and omly to receive either st and ard parenteral nutrition or an isocaloric , isonitrogenous parenteral nutrition solution containing glutamine starting on day 1 after bone marrow transplant . The two groups were well matched for diagnosis , antineoplastic treatment , and sex . MEASURES The primary clinical end points evaluated were nitrogen balance , length of hospitalization , incidence of infection , and results of microbial culture . After completion of the study , we compared the hospital charges for the categories of room and board , surgery , laboratory , pharmacy , radiology , ancillary , and miscellaneous between the two groups of patients . STATISTICAL ANALYSIS PERFORMED The two groups were compared using the unpaired t test or Mann-Whitney test for nonparametric measurements . A P value of < .05 was considered significant . RESULTS Nitrogen balance improved in the glutamine-supplemented group compared with control subjects ( -1.4 + /- 0.5 g/day vs 4.2 + /- 1.2 g/day , respectively ; P = .002 ) . Length of hospitalization was significantly shorter in the glutamine-supplemented group than in the control group ( 29 + /- 1 day vs 36 + /- 2 days , respectively ; P = .017 ) . The incidence of positive microbial cultures and clinical infection was also significantly lower with glutamine supplementation . Hospital charges were $ 21,095 per patient less in the glutamine-supplemented group compared with charges for patients who received st and ard therapy .  Room and board charges were significantly different : $ 51,484 + /- 2,647 for the glutamine-supplemented group vs $ 61,591 + /- 3,588 in the control group ( P = .02 ) . CONCLUSION This intervention study using a new therapy demonstrated clinical and nutritional benefits to patients and cost savings to the hospital BACKGROUND / AIMS Long-term total parenteral nutrition is accompanied with mucosal atrophy and subsequent malabsorption syndrome . Current information attests the important role of glutamine in maintaining intestinal structure and function . The aim of this study was to investigate the effect of glutamine 
    Output:
    
Glutamine ( i.v . )
There was no effect of oral or i.v .