Pharmacological Strategies for Mitigating Cytarabine-Induced Multi-Organ Toxicity: A Scoping Review on Mechanisms, Efficacy and Clinical Implications

This scoping review examines pharmacological strategies to mitigate cytarabine-induced multi-organ toxicity, identifying five protective pathways: redox buffering, mitochondrial preservation, tissue-microenvironment reprogramming, molecular antagonism, and immunomodulation. Among the 36 studies reviewed, apraglutide and N-acetylcysteine (NAC) emerged as promising candidates, with apraglutide improving survival in a murine model of Ara-C mucositis and NAC showing efficacy in preventing oxidative injury and positive Phase 3 clinical results in AML patients. The review highlights the need for further research, particularly in cardiotoxicity mitigation, to enhance the safety of cytarabine treatment.