Possibilities of hepatotoxicity prevention in the treatment of acute lymphoblastic leukemias in children

Background. Traditionally, supportive therapy is used to reduce severe reactions and complications during chemotherapy for acute leukemias. One of the frequent complications is the development of toxic hepatitis, which requires dose reduction or chemotherapy discontinuation until biochemical parameters improve.

Objective. To evaluate the effectiveness of prophylactic administration of a drug with hepatoprotective properties during drug therapy for acute lymphoblastic leukemias in children.

Materials and methods. A retrospective, single-center, selective, controlled observation of 76 children with acute B-lineage lymphoblastic leukemia was conducted, and the children were divided into two groups based on whether or not they had received a hepatoprotective agent for preventive purposes. A unified international scale was used to assess the degree of hepatotoxicity in accordance with the RUSSCO clinical guidelines, and the type of damage was calculated based on the known ratio of ALT and alkaline phosphatase (R criterion).

Results. The predominant type of liver damage against the background of polychemotherapy of acute leukemia turned out to be hepatocellular (R > 5) – in the first 86.2% and the second group – 95.7%. In all cases, against the background of drug therapy for leukemia, an increase in liver enzymes (ALT, AST) of various degrees was recorded during the induction and consolidation of remission. In children of the second group (receiving ursodeoxycholic acid simultaneously with the start of treatment for acute leukemia), mild degrees of hepatotoxicity were registered predominantly, whereas in children without such, the third degree was registered in 51.7% of cases, and the first degree – in only 3.4% of cases.

Conclusion. The predominant type of liver damage in drug therapy for acute lymphoblastic leukemia in children is hepatocellular. The use of a hepatoprotective agent in combination with drug therapy for acute lymphoblastic leukemia reduces the incidence of severe hepatotoxicity. 

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