Analysis of chemotherapy drug-induced liver injury in children with acute lymphoblastic leukemia based on RUCAM scale

Abstract

Objective To analyze the characteristics of drug-induced liver injury (DILI) in children with acute lymphoblastic leukemia (ALL), so as to improve the physician′s understanding of chemotherapy DILI, and to guide clinical rational drug use. Methods One hundred and forty-three cases with ALL diagnosed in the Department of Hematology and Oncology in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2016 were analyzed retrospectively.Based on DILI diagnostic criteria and the RUCAM scale, the cases with a score of ≥3 points were considered to have chemotherapy DILI.Grouped by gender, age, immunotyping, risk and stage of chemo-therapy, the incidence of DILI was compared.The situation after DILI prevention was compared between two groups which was grouped according to whether the application of hepatoprotective drugs. Results One hundred and eight cases (75.52%) had DILI, 66 cases (61.11%) showed clinical manifestations of liver injury, and 42 cases (38.89%) had no clinical symptoms.Among all the cases 57.41%(62 cases) were mild liver damage, 25%(27 cases) were moderate liver injury and 17.59%(19 cases) were severe liver damage.The clinical types which were hepatocellular accounting for 79.63%(86 cases), cholestatic 7.41%(8 cases) and mixed 12.96%(14 cases). Male were 80 cases (79.21%) and female 28 cases(66.67%), but the incidence of DILI between different gender group had no statistical difference (χ2=2.524, P=0.112). Seventy-five cases(77.32%) were 8 points accounted for 21 cases(19.45%), 6-8 points accounted for 59 cases(54.63%)and 3-5 points accounted for 28 cases(25.92%). Eighty-nine patients (92.71%) were effective in the hepatoprotective group and 8 patients (66.67%) in the no hepatoprotective therapy group.The difference between the 2 groups was statistically significant (χ2=5.317, P=0.021). Conclusions The clinical symptoms of drug-induced liver injury in children with ALL chemotherapy are lack of specificity.They are mainly characterized by mild liver injury.The clinical type of hepatic injury is common in hepatocellular.The RUCAM score was mostly 6 to 8.There is no relationship between the incidence in ALL and gender, age, type of leukemia.The incidence with moderate risk type is higher than that of the standard and high-risk type.The incidence in induction remission stage is highest.Application of hepatoprotective drugs is beneficial to DILI prognosis. Key words: Child; Acute lymphoblastic leukemia; RUCAM scale; Chemotherapy; Drug-induced liver injury