Liver disease complicating the management of acute leukemia during remission

Eight adults who developed persisting liver function abnormalities during remission from acute leukemia (6 acute nonlymphoblastic leukemia and 2 acute lymphoblastic leukemia) are reported. These patients constituted 20% of the adults with acute leukemia attaining remission over the time period studied. Although we were unable to be absolutely certain of the etiology of the liver dysfunction, the following findings characterize the problem: 1) onset following red blood cell and platelet transfusions in all cases; 2) minimal symptoms and signs except for transient episodes of jaundice; 3) fluctuating, but often marked, increases in liver transaminases; 4) no other consistent laboratory abnormalities; 5) liver biopsies showing varying degrees of inflammation; 6) a consistent decrease in transaminase levels following pulse chemotherapy; 7) absence of progression of abnormalities during the observation period. This group of patients did not have a worse prognosis than patients with normal liver function. We feel that it is important to recognize this entity and to not withhold antileukemic therapy.