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.