Effect of Chemotherapy on Liver Function During Induction of Remission in Children with Acute Lymphoblastic Leukemia Receiving Standard Protocol

Abstract

Objective: The present study was undertaken to assess liver function (using markers like SGPT, serum bilirubin, prothrombin time, serum albumin) in children suffering from Acute Lymphoblastic Leukemia.
 Materials & Methods: This study was carried out in the Department of Pediatric Hematology & Oncology, Dhaka Medical College Hospital, Dhaka, over a period 12 months from the day of approval of the protocol. All acute lymphoblastic leukaemia children admitted in Pediatric Hematology & Oncology Department in Dhaka Medical College Hospital and receiving chemotherapy of standard protocol for induction of remission were the study population. A total of outcome variable was hepatotoxicity resulting from chemotherapy given for induction of remission.
 Result: The mean age of the children was 4.4 years (range 2- 8 years). Males were a bit higher in the series with male to female ratio being 11:9. Liver function tests before therapy revealed that none of the children exhibited raised serum billirubin and only 2(4.5%) children had increased SGPT. However, 50% of the children had raised prothrombin and 43.2% had reduced serum . albumin. Liver function tests after therapy after induction of remission shows that 9(20.5%) children exhibited raised serum billirubin, the proportion of children with raised prothrombin remained almost same as before but the status of serum billirubin improved to some extent. However, proportion of children with raised SGPT was increased to 25%. Comparison of liver function in children after therapy during induction of remission with that before induction did not show any significant difference, except that the serum SGPT was significantly raised during induction of remission (p < 0.001).
 Conclusion: The study concluded that the current therapy for induction of remission of ALL cases does not produce any toxic effect on liver. Although, enzymes like SGPT take a sharp rise during induction of remission, it is transient and does produce any deleterious effect on liver.
 J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 33-37

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

“…The cause of the abnormal rise of these liver functions could be exposure to chemotherapy induction. This evidence supports the previous studies 9 , 12 , 16 , 17 , 25 . The incidence of chemotherapeutic drug-induced hepatotoxicity, which included moderate drug-induced liver injury, occurred in 15% of patients.…”

“…The incidence of chemotherapeutic drug-induced hepatotoxicity, which included moderate drug-induced liver injury, occurred in 15% of patients. These patients fully meet the criteria for clinically significant abnormalities in liver function tests 11 – 14 , indicating hepatocellular injury 10 , 12 . The mild drug-induced liver injury occurred in 5% of patients.…”

“…Genetic variation 23 and sample size could be the contributing factors to these contradicting results. Although elevated serum liver enzymes and bilirubin showed liver injury, this hepatocellular injury may be transient due to the absence of additional liver parameters such as albumin and prothrombin, which indicated the overall liver function 12 .…”

“…Hepatocellular liver injury is a prominent initial elevation of the alanine aminotransferase level, cholestatic, as evidenced by an increase in serum alkaline phosphatase levels, or mixed if both enzymes are elevated. ALT levels exceeding three times the upper limit of normal values and total bilirubin concentrations greater than twice the upper limit are defined as clinically significant abnormalities on liver tests 9 – 12 . Patients who received four or more chemotherapy drugs were at risk of experiencing adverse medication reactions 13 .…”

“…The anti-leukemic therapy given for the induction of remission did not induce hepatotoxicity except that the serum SGPT was transiently increased during the induction of remission. Elevation in serum enzyme levels is taken as an indicator of liver injury, whereas increases in bilirubin levels, albumin concentration, and prothrombin time are measures of overall liver function 12 . In Singapore 19 and the United States 20 , 10.7% and 53.9% of patients with acute lymphoblastic leukemia who received L-asparaginase had hepatic transaminase and grade 3/4 transaminitis, respectively.…”