Evaluation of liver function tests to identify hepatotoxicity among acute lymphoblastic leukemia patients who are receiving chemotherapy induction

Mekonnen, Ayal Tsegaye; Wondmeneh, Temesgen Gebeyehu

doi:10.1038/s41598-022-17618-w

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Mekonnen and Wondmeneh reported an incidence of moderate drug-induced hepatotoxicity to be 15% during ALL induction therapy. 16 While the drugs commonly used in induction specially asparaginase can cause hepatic dysfunction, voriconazole used for antifungal prophylaxis in regimen B can also cause hepatic derangements making the cause–effect association more difficult in a retrospective setting.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Dysfunction during Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma and Its Effects on Subsequent Therapy and Outcome

Reddy,

Raj,

Lashkari

2024

Indian J Med Paediatr Oncol

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Introduction The overall survival rate for childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) has shown tremendous growth in the recent years. Hepatic dysfunction is one of the complications seen during therapy and can add to the underlying morbidity of the disease, delay in chemotherapy, modification of drugs, and rarely fulminant hepatic failure. Objective This article aims to find out the prevalence of hepatic dysfunction during induction chemotherapy for ALL and LBL. Materials and Methods This was a retrospective study, where the data of all children between 1 and 18 years of age with ALL and LBL treated at our center as per the UK-ALL 2003 protocol between December 2013 and December 2021 have been included from the medical records. Hepatic dysfunction was defined as grade 3 and 4 alanine transaminase (ALT) and aspartate transaminase (AST) levels as per Common Terminology Criteria for Adverse Events v5.0 and hyperbilirubinemia as ≥ 1.4 mg/dL as the chemotherapy modification begins at this cutoff. Data from children with hepatic dysfunction was compared with those without hepatic dysfunction using chi-squared test and Student's t-tests. Those variables with a p-value of < 0.2 were analyzed with multivariate regression analysis. Kaplan–Meier survival estimates were used to calculate the event-free survival (EFS). Results A total of 142 children were included in the study. Thirty-one (21.8%) children developed hepatic dysfunction, 14 (9.9%) of them with ALT/AST elevation and 27 (19%) with bilirubin elevation. Weight (mean 25 ± 13.5, p 0.01), body surface area (mean 0.87 ± 0.29, p 0.02), and National Cancer Institute high risk (p 0.005) were associated with hepatic dysfunction in univariate analysis but none of them were significant in multivariate regression analysis. Treatment modification was required in 14/31 children with hepatic dysfunction. Death in induction was more among children with hepatic dysfunction (p < 0.001). There was no significant impact on minimal residual disease outcomes. Five-year EFS (death or relapse) was 59.93 ± 9% in children with hepatic dysfunction as opposed to 72 ± 5.0% in those without hepatic dysfunction (95% confidence interval, p = 0.07). Conclusion One in five children with ALL and LBL on induction therapy developed hepatic dysfunction. Almost half of those with hepatic dysfunction required chemotherapy modifications.

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Section: Discussionmentioning

confidence: 99%

Hepatic Dysfunction during Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma and Its Effects on Subsequent Therapy and Outcome

Reddy,

Raj,

Lashkari

2024

Indian J Med Paediatr Oncol

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“…This suggests that exposure to chemotherapeutic drugs triggers the production of ALT levels but increasing the cumulative dose of drugs may not increase ALT levels. 21 The use of L-asparaginase in ALL causes quite frequent abnormalities in liver function and may in some cases require discontinuation of treatment. One of the characteristics of impaired liver function after the administration of L-asparaginase is a slight increase in ALT levels.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Hepatotoxicity From L-Asparaginase Chemotherapy In Children With Acute Lymphoblastic Leukemia

Hikmat¹,

Andarsini²,

Setyoboedi³

et al. 2023

Pharmacogn J.

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Introduction: L-asparaginase chemotherapy often causes hepatotoxicity and affects complete remission in pediatric acute lymphoblastic leukemia (ALL). This study aims to investigate the risk factors that affect the incidence of hepatotoxicity caused by L-asparaginase chemotherapy in ALL children. Methods: An observational study with prospective sampling was conducted at Dr. Soetomo Hospital, Surabaya. The inclusion criteria included ALL children aged 1-18 years, undergoing ALL Induction phase chemotherapy based on the 2018 Indonesian Children's ALL protocol as evidenced by bone marrow aspiration, receiving L-asparaginase chemotherapy, and obtaining written consent from parents or guardians. Each child had 3 ml of blood drawn from a peripheral vein to assess their complete blood count, alanine transaminase (ALT) levels, and albumin level. Results: Thirty-two children with ALL were collected. Two of them were excluded due to allergic reaction and enable to continue the L-asparaginase chemotherapy. Thirty of them were eligible participants. Approximately 53.3% of ALL children aged ≤ seven years. Fourteen (47%) children with ALL were included in the standard-risk group and 16 (53%) of them included high-risk group. There were significant differences in ALT levels between the four stages of observation (p=<0.001). Twenty-two ALL children had hepatotoxicity (73.3%), while 8 had non-hepatotoxicity (26.7%). Two risk factors had a significant influence on the occurrence of hepatotoxicity due to L-asparaginase chemotherapy including age and hypoalbuminemia (p=0.045, p=0.028). Conclusion: Age and hypoalbuminemia were the risk factors that might affect the incidents of hepatotoxicity. Clinical monitoring before and after treatment needs to be done to prevent poor outcomes.

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“…3 Umumnya kombinasi obat yang digunakan untuk kemoterapi fase induksi pada leukemia adalah vincristine, golongan anthracycline (daunorubicin atau doxorubicin), steroid seperti prednisone atau dexamethasone, dan L-asparaginase. 9 Fase konsolidasi adalah fase intensif yang berlangsung selama beberapa bulan. 2 Tujuan kemoterapi fase konsolidasi adalah membunuh sel-sel yang mungkin selamat dari kemoterapi fase induksi serta menghentikannya kembali dan/atau menyebar ke sistem saraf pusat.…”

Section: Pendahuluanunclassified

Hubungan Pemberian Kemoterapi Fase Induksi terhadap Fungsi Hati Pasien Anak dengan Leukemia di RSUP Haji Adam Malik Medan

Fahira Mulya Suhady,

Selvi Nafianti,

Rina Amelia

et al. 2024

MEDICINUS

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Leukemia menduduki urutan sepuluh besar penyakit kanker terbanyak yang umumnya diderita oleh anak-anak. Pengobatan yang paling sering digunakan pada leukemia adalah kemoterapi. Kemoterapi pada leukemia dibagi menjadi beberapa fase, fase induksi termasuk salah satu fase kemoterapi paling singkat dan intensif. Agen kemoterapi yang digunakan dalam fase induksi umumnya memiliki potensi efek samping berupa gangguan fungsi hati. Penelitian ini bertujuan untuk menganalisis hubungan pemberian kemoterapi terhadap fungsi hati pada pasien anak dengan leukemia yang menjalani fase induksi di RSUP Haji Adam Malik Medan pada tahun 2021-2023. Penelitian ini merupakan penelitian analitik perbandingan dengan desain cross-sectional. Sampel penelitian ini adalah pasien anak dengan leukemia di RSUP Haji Adam Malik, Medan, tahun 2021-2023 sesuai dengan kriteria inklusi dan eksklusi. Pengambilan data menggunakan rekam medis dengan uji statistik Wilcoxon. Dari 100 pasien anak penderita leukemia, nilai mean dan standar deviasi kadar enzim aspartate aminotransferase (AST) sebelum dan sesudah pemberian kemoterapi fase induksi adalah 30,21±23,235 dan 37,11±25,223; serta kadar enzim alanine transaminase (ALT) memiliki rerata sebesar 48,37±62,824 dan 61,48±64,301. Hasil uji Wilcoxon antara pemberian kemoterapi fase induksi dengan parameter fungsi hati AST dan ALT menunjukkan nilai p<0,05. Terdapat hubungan yang bermakna antara pemberian kemoterapi fase induksi dengan nilai parameter fungsi hati AST dan ALT pada pasien anak dengan leukemia di RSUP Haji Adam Malik, Medan, tahun 2021-2023.

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Evaluation of liver function tests to identify hepatotoxicity among acute lymphoblastic leukemia patients who are receiving chemotherapy induction

Cited by 6 publications

References 21 publications

Hepatic Dysfunction during Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma and Its Effects on Subsequent Therapy and Outcome

Hepatic Dysfunction during Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma and Its Effects on Subsequent Therapy and Outcome

Risk Factors for Hepatotoxicity From L-Asparaginase Chemotherapy In Children With Acute Lymphoblastic Leukemia

Hubungan Pemberian Kemoterapi Fase Induksi terhadap Fungsi Hati Pasien Anak dengan Leukemia di RSUP Haji Adam Malik Medan

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