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Transplant Toxicities

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

Bone Marrow Transplantation volume 49, pages 818–823 (2014)Cite this article

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Abstract

Oral mucositis (OM) is a complication of high-dose chemotherapy (HDC) which is frequently observed in hematopoietic SCT settings. Antioxidant agents have been proposed to prevent OM and therefore N-acetyl cysteine (NAC) could have an important role. In the present study, we conducted a double-blind, randomized, placebo-controlled study to evaluate the NAC effect on OM incidence and severity, and also glutathione peroxidase-1 activity. Leukemia patients undergoing allogeneic hematopoietic SCT preceded by HDC were recruited into the study and received either NAC (100 mg/kg/day) (n=38) or placebo (n=42) from the starting day of HDC until day +15 after transplantation. OM was evaluated daily for 21 days after transplantation according to World Health Organization oral toxicity scale. The incidence of severe OM (grades 3–4) was significantly lower in the NAC group (23.7% vs 45.3%, P=0.04). Moreover, the mean duration of OM was significantly shorter in the intervention group (6.24(2.96) vs 8.12(3.97) days, P=0.02). The glutathione peroxidase-1 activity was also significantly higher in the NAC group seven days after transplantation (3.38(2.19) vs 2.41(1.70) ng/mL, P=0.003). It is concluded that parenteral NAC is effective in reducing the incidence of severe cases and the total duration of OM.

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Acknowledgements

We thank the staff of BMT wards 1, 2 and 4 (Mrs Mousavi, Mrs Shahriari and Mrs Khalilvand) at the Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital. We thank Mrs Moradkhani for her technical assistance with laboratory procedures.

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Authors and Affiliations

  1. Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    A Moslehi, K Gholami, M Hadjibabaie, Z Jahangard-Rafsanjani & M Javadi

  2. Clinical Pharmacy Department, Faculty of Pharmacy, Esfahan University of Medical Sciences, Esfahan, Iran,

    A Moslehi

  3. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran,

    M Taghizadeh-Ghehi, K Gholami, M Hadjibabaie, Z Jahangard-Rafsanjani, A Sarayani & M Javadi

  4. Hematology-Oncology and Stem cell Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    M Esfandbod & A Ghavamzadeh

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  1. A Moslehi
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Correspondence to M Hadjibabaie.

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Moslehi, A., Taghizadeh-Ghehi, M., Gholami, K. et al. N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial. Bone Marrow Transplant 49, 818–823 (2014). https://doi.org/10.1038/bmt.2014.34

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