Abstract
Objective — to evaluate the effectiveness of S-ademetionine and ursodeoxycholic acid (UDCA) combined use in the prevention of hepatotoxic reactions during chemotherapy (CT) in patients with acute lymphoblastic leukemia (ALL) and concomitant obesity.Materials and methods. Thirty patients with newly diagnosed ALL were examined, including 11 (36.7 %) women and 19 (63.3 %) men, aged 16 — 77 years. The study involved ALL patients with a body mass index (BMI) of more than 25 kg/ m2. The control group consisted of 20almost healthy people, including 9 (45 %) women, 11 (55 %) men, aged 22 — 26 years. Examination was performed before CT and on the 28th day. Indicators of biochemical blood test were determined: alanine aminotransferase (ALT), asparagine aminotransferase (AST), total protein, total bilirubin, alkaline phosphatase (AP), gamma-glutamyltranspeptidase (GGTP), urea. Assessments included arginase activity, ornithine decarboxylase (ODC) activity and citrulline levels in the blood serum. Patients were divided into 2 groups: I (n = 14) — patients, who received 15 mg/ kg/ day UDCA during CT from the 1st till the 28th day; II (n = 16) — patients, who were prescribed a combination of S-ademetionine at a dose of 1000 mg/ day intravenously during 10 days, then orally 1000 mg/ day until the 28th day and UDCA at a dose of 15 mg/ kg/ day during 1st till 28th day.Results and discussion. In patients with ALL and concomitant obesity, against the background of manifestations of the onco-hematological disease, the liver injury development was observed, characterized by the increased activity of ALT, AP, GGTP, total bilirubin (p < 0.05), as well as increased arginase, ODC activities and citrulline content in the blood serum (p < 0.05). The combination of S-ademetionine and UDCA, prescribed during CT, allowed to reduce the AP activity in 1.8 times, GGTP — in 1.4 times (p < 0.05), ODC — in 1.8 times, citrulline levels — in 2.4 times (p < 0.05). There was a 1.5-fold reduction of Arginase/ citrulline ratio (p < 0.05), which indicates a decreased activity of the NOS pathway of arginine metabolism.Conclusions. The S-ademetionine and UDCA combined use during CT has reduced the manifestations of cytolytic and cholestatic syndromes and effectively prevented the hepatotoxic reactions development.
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