SERUM ALANINE AMINOTRANSFERASE ELEVATION IN CHILDREN WITH LEUKEMIA OR LYMPHOMA DURING CHEMOTHERAPY

Gao YJ, Wu Y, Lu FJ, Wu ChG

Children¡¯s Hospital, Fudan University, Shanghai, China

 

Objective: To determine the prevalence and the cause of serum alanine aminotransferase (ALT) elevation in children with leukemia/lymphoma during chemotherapy . 

Method: ALT (upper normal limit, 40u/L), serum bilirubin, prothrombin time, antiHAV-IgM, HBsAg, HbeAg, antiHBV-IgM, antiHBc, HBV-DNA, antiHCV, antiHDV and antiHEV were measured periodically during therapy. 

Results: One hundred children with leukemia/lymphoma were treated between 1995 and 2000.  58 of these patients (58%) had an ALT level>40u/L during chemotherapy.  Of 58 patients, 7 (12.1%) were HBV-seropositive, 6 (10.3%) were antiHCV positive, 2 had heart failure due to severe myocardiopathy caused by anthracyclines, 2 were relapsed patients with extensive extramedullary infiltration.  All those cases with HBV/HCV infection were seronegative pre-chemotherapy, and have received blood products during treatment. 

Conclusion: ALT elevations are common during chemotherapy in children with leukemia/lymphoma. Most of these elevations (70.7%) are secondary to chemotherapeutic agents (high-dose MTX in particularly). Drug-induced ALT elevations are absence of other liver function abnormal presence (p<0.05), chemotherapy can be continued without delay; persistent ALT increasing may indicate hepatitis virus infection. AntiCMV-IgM, antiHGV and HCV-RNA might also be detected in patients with unexplainable ALT elevation.

 

 

 
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