Pattern of Transaminases in Relation to Chemotherapy in Patients with Acute Lymphoblastic Leukemia as a Predictor of Hepatotoxicity

Manal H. El-Sayed; Samar M. Farid; Shereen M. Abd El-Ghany; Al-Shimaa M. Abd El-Aziz

doi:10.12816/0029220

Article Details

Pattern of Transaminases in Relation to Chemotherapy in Patients with Acute Lymphoblastic Leukemia as a Predictor of Hepatotoxicity

Authors:

Manal H. El-Sayed | Samar M. Farid | Shereen M. Abd El-Ghany | Al-Shimaa M. Abd El-Aziz

Publisher:

Ain Shams University : Egyptian Paediatric Society

Main Topics:

Medicine

Journal:

Egyptian Journal of Pediatrics 2014 Vol.31 Issue 3-4, pp.285-300

Document Type:

Article

Publication Date:

12/2014

Document Language:

English

Document ID (Org No.):

91286

Frequency:

Quarterly

pISSN:

16871677

DOI:

10.12816/0029220

Descriptors:

Abstract:

 Background and Aim: Chemotherapeutics are usually implicated in causing liver dysfunction in childhood leukemia. We retrospectively evaluated the effect of chemotherapeutic agents in different phases of BFM-90 and modified CCG protocols on liver transaminases in survivors of acute lymphoblastic leukemia (ALL).
Patients & Methods: Ninety-nine patients (52:47 M:F; median age 11 years) were included in this study, they were divided into: group A included 49 patients treated with BFM-90 protocol for standard risk (SRG), group B included 33 patients treated with modified CCG 1991 SR protocol and group C included 17 patients treated with modified CCG 1961 high risk protocol.
Results: There were significantly higher liver transaminases among patients in group A compared to group B (P<0.05) during the consolidation phase, resulting from the use of high dose methotrexate, and during maintenance phase compared to group B and C (P<0.05), coinciding with the use of oral methotrexate and 6-mercaptopurine. Patients with HBV/HCV infection had significantly higher number of hepatitis flares (p=0.041), more frequent dose modification of chemotherapy (p=0.003), higher ALT and AST at the end of chemotherapy (p<0.001) and during follow-up period (p= 0.013, p= 0.011, respectively) compared to HBV/HCV negative patients.
Conclusion: Maintenance therapy using known hepatotoxic drugs such as 6-MP and methotrexate continue to be a major threat to the liver of children undergoing treatment for ALL. Infection with Hepatitis B and C viruses may have additive deleterious effect. Severe irreversible hepatic dysfunction was not reported among HCV and HBV infected patients received ALL treatment.

Article Details

Pattern of Transaminases in Relation to Chemotherapy in Patients with Acute Lymphoblastic Leukemia as a Predictor of Hepatotoxicity

Authors:

Manal H. El-Sayed | Samar M. Farid | Shereen M. Abd El-Ghany | Al-Shimaa M. Abd El-Aziz

Publisher:

Ain Shams University : Egyptian Paediatric Society

Main Topics:

Medicine

Journal:

Egyptian Journal of Pediatrics 2014 Vol.31 Issue 3-4, pp.285-300

Document Type:

Article

Publication Date:

12/2014

Document Language:

English

Document ID (Org No.):

91286

Frequency:

Quarterly

pISSN:

16871677

DOI:

10.12816/0029220

Descriptors:

MEDICAL SCIENCES

PAEDIATRICS

LIVER DISEASES

AMINOTRANSFERASES

ACUTE LYMPHOBLASTIC LEUKEMIA

CHEMOTHERAPY

PATIENTS

Issues

Article Details

Authors: Manal H. El-Sayed | Samar M. Farid | Shereen M. Abd El-Ghany | Al-Shimaa M. Abd El-Aziz

Publisher: Ain Shams University : Egyptian Paediatric Society

Main Topics: Medicine

Journal: Egyptian Journal of Pediatrics 2014 Vol.31 Issue 3-4, pp.285-300

Document Type: Article

Publication Date: 12/2014

Document Language: English

Document ID (Org No.): 91286

Frequency: Quarterly

pISSN: 16871677

DOI: 10.12816/0029220

Descriptors:

Issues

Authors:

Manal H. El-Sayed | Samar M. Farid | Shereen M. Abd El-Ghany | Al-Shimaa M. Abd El-Aziz

Publisher:

Ain Shams University : Egyptian Paediatric Society

Main Topics:

Medicine

Journal:

Egyptian Journal of Pediatrics 2014 Vol.31 Issue 3-4, pp.285-300

Document Type:

Article

Publication Date:

12/2014

Document Language:

English

Document ID (Org No.):

91286

Frequency:

Quarterly

pISSN:

16871677

DOI:

10.12816/0029220