Barkholt L, Remberger M, Hassan Z, Fransson K, Omazic B, Svahn B-M, Karlsson H, Brune M, Hassan M, Mattsson J, Ringdén O
Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Bone Marrow Transplant. 2008 May;41(9):785-90. doi: 10.1038/sj.bmt.1705969. Epub 2008 Jan 7.
Allogeneic hematopoietic stem cell transplantation (ASCT) and its conditioning with chemoradiotherapy often results in liver toxicity, the most severe form being veno-occlusive liver disease (VOD). N-acetyl-L-cysteine (NAC), an antioxidant glutathione precursor, may provide protection from liver toxicity. Patients with elevated bilirubin (>26 mmol/l) and/or elevated (ALT) (>1.4 microkat/l) and/or aspartate aminotransferase (AST) (>1.4 microkat/l) levels were randomized to treatment with NAC or no treatment. Among 522 transplanted patients, 160 were included in the trial. NAC was given, 100 mg/kg per day, as a 6-h i.v. infusion until normalization of bilirubin, ALT and AST values. Maximum bilirubin level was the same in patients randomized to NAC (n=72) or controls (n=88). Increase and recovery of ALT and AST were the same in patients randomized to NAC or controls. There were two patients in the NAC group who developed VOD, as compared to three of the controls. To conclude, NAC does not improve liver toxicity after ASCT.
异基因造血干细胞移植（ASCT）及其放化疗预处理常导致肝毒性，最严重的形式是肝静脉闭塞病（VOD）。N-乙酰半胱氨酸（NAC）是一种抗氧化剂谷胱甘肽前体，可能对肝毒性起到保护作用。将胆红素升高（>26 mmol/l）和/或谷丙转氨酶（ALT）升高（>1.4微卡特/升）和/或天冬氨酸转氨酶（AST）升高（>1.4微卡特/升）的患者随机分为接受NAC治疗组或不治疗组。在522例移植患者中，160例被纳入试验。NAC的给药剂量为每天100 mg/kg，静脉滴注6小时，直至胆红素、ALT和AST值恢复正常。随机接受NAC治疗的患者（n=72）和对照组患者（n=88）的最高胆红素水平相同。随机接受NAC治疗的患者与对照组患者的ALT和AST升高及恢复情况相同。NAC组有2例患者发生VOD，而对照组有3例。总之,ASCT术后NAC不能改善肝毒性。
