Biochemical peculiarities of liver injury in patients with acute lymphoblastic leukemia of standard risk

Abstract

The specific chemotherapy (CT) in patients with acute lymphoblastic leukemia (ALL) is accompanied by a risk of the liver functional state violation. However, there are still many unsolved questions regarding the hepatotoxicity of cytostatic drugs, since hepatic tests’ impairment develops not in all patients.Objective — to determine the nature of changes in biochemical liver tests in patients of standard risk in the dynamics of remission induction chemotherapy.Materials and methods. The examinations involved 22 patients with newly diagnosed ALL, from them 8 (36.4 %) women and 14 (63.6 %) men; mean age was (27.8 ± 14.8) years. Patients complied with criteria of the standard risk group, who achieved clinical and hematological remission on the 28th day of treatment. Patients were examined at baseline before the CT and on the 28th day of treatment, the panel biochemical parameters were determined. The severity of hepatotoxic reactions was evaluated according to the criteria of Common Terminology Criteria for Adverse Events (CTCAE), Version 4.02.Results and discussion. The ALL debut in patients of standard risk in 81.8 % of cases was accompanied by violations of the functional liver state characterized by cytolytic, cholestatic and mixed types and did not exceed the 1st grade of CTCAE.The achievement of clinical-hematologic remission was accompanied by a decrease in the number of patients with liver test abnormalities. Increasing activity of ALT, AST, ALP, GGTP, LDH and the concentration of bilirubin and its fractions in the blood serum on the 28th day of therapy was revealed in 14 (63.8 %) patients. In patients with ALL of standard risk without violations of functional liver tests at baseline, during the CT induction, no increase in the activity of ALT, AST, LF, GGTP, LDH, and serum levels of bilirubin and its fractions was observed. The L-asparaginase administration to the patients with ALL of standard risk in the dynamics of remission induction was accompanied by a decrease in the blood serum levels of total protein in 1.3 times compared to the baseline examination (р < 0.05).Conclusions. The conduction of the remission induction to the ALL patients of the standard risk group was characterized by the lowering the serum total protein level, wich did not depend on the transaminases’ activity and was associated with the L-asparaginase treatment; this should be taken into account when choosing the supportive therapy.