The Integrative Therapies Program has a long list of breakthroughs in the study of nutrition and dietary supplements for children with cancer.
- Milk Thistle (MT): Since milk thistle is widely used in complementary and alternative medicine, our investigators have evaluated its use in both the laboratory and clinical settings. In a double-blind study, children with acute lymphoblastic leukemia (ALL) and hepatic toxicity were randomized to Milk Thistle or placebo orally for 28 days. Liver function tests were evaluated during the study period. To assess MT in vitro, the authors evaluated supra-therapeutic concentrations in an ALL cell line. We found that MT was associated with a trend toward significant reductions in liver toxicity. Further MT did not interact adversely with chemotherapy agents used to treat these patients. Future study is needed to determine the most effective dose of MT and its duration as well as its effect on hepatotoxicity and leukemia-free survival. In 2010, these results appeared in the journal Cancer.
- Glutamine: In 2004, the Integrative Therapies Program pioneered research into the use of glutamine to reduce toxicities in pediatric cancer patients, noting that these toxicities may result in a reduction of chemotherapy or delay in treatment protocols. The nutritional supplement, glutamine, is classified as a nutritional supplement and is currently not an established supportive care agent in use with conventional chemotherapy protocols. However, the low toxicity and possible plausibility of glutamine suggests it may be of benefit for children undergoing anticancer protocols and may ameliorate the neurotoxic effect of the chemotherapy agent Vincristine (VCR). The ITP is now completing the first study (a double-blind, randomized, placebo-controlled trial) to investigate the efficacy of glutamine in the treatment of VCR induced neuropathy in children with cancer.
- Probiotics: Dr. Ladas and her colleagues are shedding new light on a controversial issue—the use of probiotics in children who receive stem cell transplants. The toxicities associated with hematopoietic stem cell transplantation (HSCT) often lead to prolonged loss of appetite and may result in malnutrition. Compromised gut integrity decreases food tolerance, quality of life and overall ability to function, delaying the transition from the hospital to home setting, and increasing the risk of gut-related infections. Probiotics are nutritional supplements that contain a defined amount of viable microorganisms. Clinical trials in adults receiving organ transplants have shown that probiotics decrease the incidence of infection, the duration of antibiotic administration, the incidence of multi-organ failure and systemic inflammation. Children and adolescents undergoing HSCT experience similar clinical challenges. Our preliminary research indicates that probiotics may be administered safely, and we will soon be participating in a large multicenter trial to validate this finding with the Children’s Oncology Group.
- Yunnan Baiyao: Yunnan Baiyao (YNB) is a Chinese herbal medicinal powder used to stop bleeding and improve circulation in traumatic injuries. Our clinicians have explored its use in adolescents with cancer as an adjunct to uncontrolled bleeding in the palliative care setting. All patients studied received packed red blood cells and platelet transfusions, topical thrombin, and oral aminocaproic acid. Bleeding control improved with the addition of YNB with no adverse events. This herb was well accepted and may prove especially valuable in the outpatient setting to prevent the recurrent hemorrhaging. We published our findings in the journal Supportive Care in Cancer and future plans include the evaluation of YNB in a controlled setting.