Micronutrient interaction in the management of patients following bone marrow transplantation.

Hunnisett A G W PhD Thesis, Oxford Brooks University, 1996 Bone marrow transplantation (BMT) is an accepted form of treatment for haematological malignancies. It is also being used increasingly as a rescue treatment for patients with advanced solid organ tumours whose own bone marrow has been destroyed by high doses of chemotherapy of radiotherapy used against the malignancy. Despite its widespread use, however, the overall success rates of BMT is still rather poor with many centres reporting survival figures of little more than 50%. Many of the problems associated with the procedure may arise from the use of high dose chemotherapy and total body irradiation used as a conditioning therapy prior to the actual marrow transplant. This thesis examines how conditioning therapy affects micronutrient concentrations and how the resultant changes might be addressed in various post-transplant treatment regimens. A total of 33 patients were entered into the project. Prior to any form of treatment the patient group was compared to a normal population to assess any differences in nutrient concentrations between them. A wide variety of micronutrient assays were carried out pre-treatment, following conditioning therapy and at regular intervals over the post-transplant course of each patient. Following conditioning therapy, the patients were sequentially divided into 3 groups, a control group (Group 1) following the normal treatment protocols, a limited intervention group (Group 2) essentially having increased micronutrient levels added to the TPN feeding regimen and a high-dose antioxidant treatment group (Group 3) treated with high doses of antioxidants. Marked abnormalities in micronutrient values were found following conditioning therapy which were improperly addressed by the then current post-operative feeding regimen. The abnormalities were particularly marked with respect to indices of free radical activity. The significance of these changes are discussed with respect to the clinical course of the patients, their overall survival and how the various post-transplant treatment regimens addressed the problems.