Chemotherapy induced liver toxicity in children with malignant diseases

H. Adrienne, Papp Zsuzsanna Erzsébet
{"title":"Chemotherapy induced liver toxicity in children with malignant diseases","authors":"H. Adrienne, Papp Zsuzsanna Erzsébet","doi":"10.2478/orvtudert-2018-0002","DOIUrl":null,"url":null,"abstract":"Abstract A broad spectrum of chemotherapy is being used in the therapy of childhood cancers, which may induce liver injury, impairing quality of life and efficacy of the treatment. History of, especially viral, liver diseases may increase toxicity. The aim of the paper is to assess the incidence, type and grade, predisposing factors and treatment options of drug-induced liver injury in children with malignant diseases under cytostatic therapy at the Hemato-Oncology Department of the Pediatric Clinic 2 from Targu-Mures, over a time period spanning from 2012 to 2017. The results of the study may serve as a foundation for such treatment strategies which would enable optimal outcomes with fewer cases of liver toxicity. During this period, we treated 26 patients with acute lymphoblastic leukemia (ALL), two patients with acute myeloblastic leukemia (AML), one patient with lymphoma and seven with solid tumors. We found liver toxicity in 77% of the patients treated for ALL, mainly during the maintenance therapy (65%) with oral 6-mercaptopurine and methotrexate. The most common clinical signs were anorexia, nausea, vomiting, abdominal pain and faltering weight gain. Cholestasis developed in two patients, while hepatocytolysis was the most common observed event (n = 24). Liver fibrosis, hypersplenism, portal hypertension and esophageal varices were found in two patients. One patient required endoscopic ligation of esophageal varices. Elevation of serum bilirubin appeared in two patients, while hypoproteinemia was observed in nine patients. None of the patients developed acute liver failure. We treated liver toxicity with hydration, alkalinization, i.v. Aspatofort, Aminosteril-N Hepa 8%, oral acetylcysteine, silymarin, ursodeoxycholic acid, Liv-52, Sargenor, and Essentiale forte. We found hepatotoxicity in 77% of the ALL patients undergoing chemotherapy, similar results have been published by other authors. Hepatotoxicity may develop through direct hepatic effects of cytostatics, or a preexisting liver disease impairs the metabolism and excretion of the drug, increasing its toxic effects. In our patients hepatotoxicity can be explained mainly by direct liver-injury, previous infections with hepatotropic viruses, such as cytomegalovirus, were detected only in three patients. Liver injury appeared in 77% of our ALL patients; 65% occurred during maintenance therapy with oral 6-mercaptopurine and methotrexate. Close followup of liver function during chemotherapy is mandatory for optimal results.","PeriodicalId":9334,"journal":{"name":"Bulletin of Medical Sciences","volume":"64 1","pages":"37 - 41"},"PeriodicalIF":0.0000,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bulletin of Medical Sciences","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2478/orvtudert-2018-0002","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1

Abstract

Abstract A broad spectrum of chemotherapy is being used in the therapy of childhood cancers, which may induce liver injury, impairing quality of life and efficacy of the treatment. History of, especially viral, liver diseases may increase toxicity. The aim of the paper is to assess the incidence, type and grade, predisposing factors and treatment options of drug-induced liver injury in children with malignant diseases under cytostatic therapy at the Hemato-Oncology Department of the Pediatric Clinic 2 from Targu-Mures, over a time period spanning from 2012 to 2017. The results of the study may serve as a foundation for such treatment strategies which would enable optimal outcomes with fewer cases of liver toxicity. During this period, we treated 26 patients with acute lymphoblastic leukemia (ALL), two patients with acute myeloblastic leukemia (AML), one patient with lymphoma and seven with solid tumors. We found liver toxicity in 77% of the patients treated for ALL, mainly during the maintenance therapy (65%) with oral 6-mercaptopurine and methotrexate. The most common clinical signs were anorexia, nausea, vomiting, abdominal pain and faltering weight gain. Cholestasis developed in two patients, while hepatocytolysis was the most common observed event (n = 24). Liver fibrosis, hypersplenism, portal hypertension and esophageal varices were found in two patients. One patient required endoscopic ligation of esophageal varices. Elevation of serum bilirubin appeared in two patients, while hypoproteinemia was observed in nine patients. None of the patients developed acute liver failure. We treated liver toxicity with hydration, alkalinization, i.v. Aspatofort, Aminosteril-N Hepa 8%, oral acetylcysteine, silymarin, ursodeoxycholic acid, Liv-52, Sargenor, and Essentiale forte. We found hepatotoxicity in 77% of the ALL patients undergoing chemotherapy, similar results have been published by other authors. Hepatotoxicity may develop through direct hepatic effects of cytostatics, or a preexisting liver disease impairs the metabolism and excretion of the drug, increasing its toxic effects. In our patients hepatotoxicity can be explained mainly by direct liver-injury, previous infections with hepatotropic viruses, such as cytomegalovirus, were detected only in three patients. Liver injury appeared in 77% of our ALL patients; 65% occurred during maintenance therapy with oral 6-mercaptopurine and methotrexate. Close followup of liver function during chemotherapy is mandatory for optimal results.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
广泛的化疗方案正被用于儿童癌症的治疗,这可能会导致肝损伤,影响生活质量和治疗效果。肝脏疾病史,特别是病毒性肝病史,可增加毒性。本文的目的是评估2012年至2017年期间Targu-Mures儿科诊所2血液肿瘤科接受细胞抑制剂治疗的恶性疾病儿童药物性肝损伤的发生率、类型和分级、易感因素和治疗方案。该研究的结果可以作为这种治疗策略的基础,这将使更少的肝毒性病例获得最佳结果。在此期间,我们治疗了26例急性淋巴细胞白血病(ALL), 2例急性髓母细胞白血病(AML), 1例淋巴瘤和7例实体瘤。我们发现77%的ALL患者出现肝毒性,主要是在口服6-巯基嘌呤和甲氨蝶呤的维持治疗期间(65%)。最常见的临床症状是厌食、恶心、呕吐、腹痛和体重增加缓慢。2例患者出现胆汁淤积,而肝细胞溶解是最常见的观察事件(n = 24)。2例患者出现肝纤维化、脾功能亢进、门脉高压及食管静脉曲张。1例患者需要内镜结扎食管静脉曲张。2例患者出现血清胆红素升高,9例患者出现低蛋白血症。没有患者出现急性肝功能衰竭。我们用水合、碱化、静脉注射阿斯帕妥福、氨固醇- n - Hepa 8%、口服乙酰半胱氨酸、水水蓟素、熊去氧胆酸、Liv-52、Sargenor和Essentiale forte治疗肝毒性。我们发现77%接受化疗的ALL患者出现肝毒性,其他作者也发表了类似的结果。肝毒性可通过细胞抑制剂对肝脏的直接作用而发展,或先前存在的肝脏疾病损害药物的代谢和排泄,增加其毒性作用。在我们的患者中,肝毒性主要可以通过直接肝损伤来解释,既往感染嗜肝病毒,如巨细胞病毒,仅在3例患者中检测到。77%的ALL患者出现肝损伤;65%发生在口服6-巯基嘌呤和甲氨蝶呤维持治疗期间。在化疗期间密切随访肝功能是获得最佳结果的必要条件。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Quality by design-based method development for the determination of related substances of ezetimibe by high performance liquid chromatography Determination of the sun protection factor of sunscreens Alzheimer’s disease beyond the amyloid accumulation Radioactive background radiation measurement in Mureş county Study of pulmonary complications in patients referred to the intensive care unit
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1