Abstract
Purpose:
Hepatic dysfunction is a rare presentation of leukemia in children. Because most chemotherapy agents are metabolized by the liver, this complication may have major adverse consequences and effective treatment could be compromised.
Patients and methods:
The MEDLINE database and current management guidelines from the United States Pediatric Cooperative Cancer Groups were reviewed and analyzed. Data from two institutional cases are described.
Results:
Although previous literature is not informative, our experience suggests that children with leukemia and moderate hepatic dysfunction may tolerate aggressive chemotherapy.
Conclusion:
Current protocol guidelines for dose modification for liver disease may be overly stringent and modification may be beneficial.
MeSH terms
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Adolescent
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Antineoplastic Combined Chemotherapy Protocols / pharmacokinetics
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Asparaginase / administration & dosage
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Asparaginase / pharmacokinetics
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Biopsy
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Child, Preschool
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Cholestasis, Intrahepatic / etiology*
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Cholestasis, Intrahepatic / pathology
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Chromosome Deletion
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Daunorubicin / administration & dosage
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Daunorubicin / pharmacokinetics
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Hepatomegaly / diagnostic imaging
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Hepatomegaly / etiology*
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Hepatomegaly / pathology
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Humans
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Liver / physiopathology
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Liver Function Tests
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Male
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Mercaptopurine / administration & dosage
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Methotrexate / administration & dosage
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Practice Guidelines as Topic
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Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / complications*
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Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / diagnosis
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Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
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Prednisone / administration & dosage
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Prognosis
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Remission Induction
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Thrombocytopenia / etiology
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Ultrasonography
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Vincristine / administration & dosage
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Vincristine / pharmacokinetics
Substances
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Vincristine
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Mercaptopurine
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Asparaginase
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Prednisone
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Methotrexate
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Daunorubicin