Drug-Induced Liver Injury during Consolidation Therapy in Childhood Acute Lymphoblastic Leukemia as Assessed for...

Area of Science:

• Pediatric Oncology
• Hepatology
• Pharmacology

Background:

• Serious toxicities complicate childhood acute lymphoblastic leukemia (ALL) treatment.
• Drug-induced liver injury (DILI) is a significant concern during ALL consolidation therapy.

Purpose of the Study:

• To evaluate the incidence, patterns, and risk factors of DILI in pediatric ALL patients undergoing consolidation therapy.
• To identify the main causative agents of DILI in different risk groups.

Main Methods:

• Retrospective analysis of clinical data from pediatric ALL patients (August 2012-July 2018).
• Assessment of DILI characteristics, risk factors using logistic regression, and causality using Roussel Uclaf Causality Assessment Method (RUCAM).

Main Results:

• DILI incidence was higher in high-risk (HR) patients (5.6%) compared to standard/intermediate-risk (SR/IR) patients (2.5%).
• Risk factors for DILI in SR/IR patients included younger age, more treatment courses, and specific baseline serum parameters (cystatin C, albumin, GGT).
• High-dose methotrexate (HD-MTX), high-dose cytarabine (HD-Ara-C), and pegylated asparaginase (PEG-ASP) were identified as primary causative agents.

Conclusions:

• HR patients exhibit a significantly higher incidence of DILI.
• Preexisting liver conditions may be a shared risk factor for DILI across all risk groups.
• Understanding DILI characteristics and causative agents is crucial for optimizing childhood ALL consolidation therapy.