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Abnormal liver transaminases and conjugated hyperbilirubinemia at presentation of acute lymphoblastic leukemia.
Pediatr Blood Cancer. 2010 Sep; 55(3):434-9.PB

Abstract

BACKGROUND

Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. While hepatitis is a well-known complication during the treatment phase of ALL, the association of abnormal liver biochemistries at initial presentation of leukemia is poorly described. The aim of this study is to examine the prevalence and assess the clinical impact of hepatitis at diagnosis in children with ALL.

PROCEDURE

All children diagnosed with ALL at BC Children's Hospital between 2001 and 2006 were included. Charts were reviewed and data recorded to a computerized spreadsheet. Descriptive statistical analyses were performed.

RESULTS

One hundred forty-seven ALL patients were identified. Over one third of patients had abnormal liver transaminase values (AST and/or ALT). Of the patients with abnormal transaminases, (52%) had ALT elevations twice the upper limit of normal. Risk factors for elevated transaminases included a high WBC count at diagnosis, older age, bulky disease, and T-cell leukemia. Conjugated hyperbilirubinemia was observed in 3.4% of subjects. Of these cases, 60% received steroids prior to induction chemotherapy and all had rapid resolution of their hyperbilirubinemia to normal levels.

CONCLUSIONS

Elevated transaminases are common at initial presentation of ALL and are likely due to hepatic injury from leukemic infiltrates. Conjugated hyperbilirubinemia at presentation may require treatment modification and dose reduction. A short course of steroids prior to initiation of induction chemotherapy appears to result in rapid resolution of the hyperbilirubinemia with subsequent ability to provide full dosing of induction chemotherapy.

Authors+Show Affiliations

Division of Pediatric Gastroenterology, Department of Pediatrics, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20658613

Citation

Segal, Idit, et al. "Abnormal Liver Transaminases and Conjugated Hyperbilirubinemia at Presentation of Acute Lymphoblastic Leukemia." Pediatric Blood & Cancer, vol. 55, no. 3, 2010, pp. 434-9.
Segal I, Rassekh SR, Bond MC, et al. Abnormal liver transaminases and conjugated hyperbilirubinemia at presentation of acute lymphoblastic leukemia. Pediatr Blood Cancer. 2010;55(3):434-9.
Segal, I., Rassekh, S. R., Bond, M. C., Senger, C., & Schreiber, R. A. (2010). Abnormal liver transaminases and conjugated hyperbilirubinemia at presentation of acute lymphoblastic leukemia. Pediatric Blood & Cancer, 55(3), 434-9. https://doi.org/10.1002/pbc.22549
Segal I, et al. Abnormal Liver Transaminases and Conjugated Hyperbilirubinemia at Presentation of Acute Lymphoblastic Leukemia. Pediatr Blood Cancer. 2010;55(3):434-9. PubMed PMID: 20658613.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abnormal liver transaminases and conjugated hyperbilirubinemia at presentation of acute lymphoblastic leukemia. AU - Segal,Idit, AU - Rassekh,S Rod, AU - Bond,Mason C, AU - Senger,Christof, AU - Schreiber,Richard A, PY - 2010/7/27/entrez PY - 2010/7/27/pubmed PY - 2010/8/13/medline SP - 434 EP - 9 JF - Pediatric blood & cancer JO - Pediatr Blood Cancer VL - 55 IS - 3 N2 - BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. While hepatitis is a well-known complication during the treatment phase of ALL, the association of abnormal liver biochemistries at initial presentation of leukemia is poorly described. The aim of this study is to examine the prevalence and assess the clinical impact of hepatitis at diagnosis in children with ALL. PROCEDURE: All children diagnosed with ALL at BC Children's Hospital between 2001 and 2006 were included. Charts were reviewed and data recorded to a computerized spreadsheet. Descriptive statistical analyses were performed. RESULTS: One hundred forty-seven ALL patients were identified. Over one third of patients had abnormal liver transaminase values (AST and/or ALT). Of the patients with abnormal transaminases, (52%) had ALT elevations twice the upper limit of normal. Risk factors for elevated transaminases included a high WBC count at diagnosis, older age, bulky disease, and T-cell leukemia. Conjugated hyperbilirubinemia was observed in 3.4% of subjects. Of these cases, 60% received steroids prior to induction chemotherapy and all had rapid resolution of their hyperbilirubinemia to normal levels. CONCLUSIONS: Elevated transaminases are common at initial presentation of ALL and are likely due to hepatic injury from leukemic infiltrates. Conjugated hyperbilirubinemia at presentation may require treatment modification and dose reduction. A short course of steroids prior to initiation of induction chemotherapy appears to result in rapid resolution of the hyperbilirubinemia with subsequent ability to provide full dosing of induction chemotherapy. SN - 1545-5017 UR - https://www.unboundmedicine.com/medline/citation/20658613/Abnormal_liver_transaminases_and_conjugated_hyperbilirubinemia_at_presentation_of_acute_lymphoblastic_leukemia_ L2 - https://doi.org/10.1002/pbc.22549 DB - PRIME DP - Unbound Medicine ER -