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Multicenter study on magnesium isoglycyrrhizinate preventing novel antitumor-induced liver injury in hematological
Chen Liang1,2, Li Liu1,2, Rongli Zhang1,2
1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Background:
Antineoplastic agents significantly contribute to drug-induced liver injury (DILI). This study evaluates magnesium isoglycyrrhizinate (MgIG) for preventing DILI in hematological malignancy patients receiving novel antitumor therapies.
Methods:
This multicenter retrospective analysis included hematological malignancy patients treated with hepatoprotective agents across 13 Chinese centers (December 2023-February 2024). Primary outcomes assessed liver injury incidence and severity at 21, 30, and 60 days; secondary outcomes evaluated safety.
Results:
Propensity score-matched cohorts (MgIG = 324, control = 182) showed balanced baselines. MgIG recipients had higher chemotherapy (91.4 vs. 64.3%, P < 0.001) and Venetoclax exposure (26.2 vs. 2.2%, P < 0.001). Baseline AE incidence was higher with MgIG (4.6 vs. 0.5%, P = 0.014), but subsequent follow-ups showed comparable AE rates. Hepatic injury incidence was similar (4.2 vs. 4.0%, P > 0.05). Controls exhibited greater ALT, AST and γ-GGT elevations at day 30 and γ-GGT elevation at day 60 (all P < 0.05). MgIG reduced overall hepatic AEs (48.0 vs. 66.7%, P < 0.001), driven by fewer grade 1-2 abnormalities (43.5 vs. 60.3%, P < 0.001), though grade ≥2 events remained comparable. Interim assessments revealed higher hepatic AE rates in controls at day 21 (54.5 vs. 37.1%) and day 30 (55.7 vs. 34.1%; P < 0.001), with elevated grade ≥2 AEs by day 60 (18.6 vs. 8.6%, P = 0.022).
Conclusions:
Prophylactic MgIG attenuates antineoplastic therapy-induced ALT/AST/TBiL elevations in hematological malignancies, demonstrating hepatoprotective efficacy. While its impact on overall DILI incidence remains unclear, longitudinal data suggest clinically meaningful mitigation of hepatotoxicity severity in high-risk subgroups during critical phases.
