| BackgroundObjective Acute lymphoblastic leukemia(ALL) is the most common malignant tumor in children. Early continued combination chemotherapy can kill leukemia cells in the body to the greatest extent, reduce the secondary resistance and small residual disease, so as to improve the long-term disease-free survival(EFS). Many chemotherapy drugs have liver toxicity and their related liver injury affected the application and therapeutic effect of chemotherapy to a certain extent. During chemotherapy process, many factors may be associated with liver injury, such as gender, age, chemotherapy regimens, ALL risk classification and whether protect measures were taken, etc. Doctors should pay great attention to liver injury caused by chemotherapy in ALL, especially in children whose growth and function of liver cells are immature. The assessment of drug-induced liver injury(DILI)released by Danan is the most suitable candidate for clinical diagnosis of DILI in China.Purpose ALL cases in our hospital were analyzed according to the assessment of DILI released by Danan, so as to choose proper chemotherapy regimens and effective protective measures, thereby reducing the occurrence of DILI and ensure the smooth progress of chemotherapy.Methods Children diagnosed with ALL from January 1, 2009 to January 1, 2014 in General Hospital of Ningxia Medical University were analyzed according to the assessment of DILI released by Danan and SPSS17.0 software was used in statistical analysis.χ2 test,Rank sum test, independent two-sample t-test and analysis of variance were used in the data analysis.The correlation between liver injury and some influence factors, such as age, stage of chemotherapy, ALL risk classification, the time of liver injury and its recovery, whether the protect measure was taken and its effect, hepatitis B virus(HBV) infection was analyzed.Results 120 patients were enrolled, including 89 boys( accounting for 74.16%) and 31 girls(25.83%). After chemotherapy, DILI occurred in 83 cases, with the incidence of 69.16%, among which 61 were boys and 22 were girls. No statistical difference was found either between boys and girls or between four degrees of liver injury. Statistical significance(P < 0.001) was found in the average age of the liver injury degree. mild liver injury was most common in 0 to 3 years group, abnormal liver function and moderate liver injury was most common in 3 to 7 years group. Statistical significance(P< 0.05) was found in the incidence of liver injury in different chemotherapy stage, with the highest incidence in high-dose MTX + 6-MP stage, while the liver injury degree in different chemotherapy stage had no significantly statistical difference(P > 0.05). Statistical difference(P < 0.05) was found in the liver injury rate in different risk types of ALL, among which high-risk type had the highest incidence. There was no statistical difference in the onset of liver injury in different chemotherapy regimens(P>0.05), with the VDLD regimen 6.81±0.51 days, CAM regimen 6.76±0.41 days and high dose MTX+6-MP 7.11±0.79 days. The liver function of patients who received protective medicine recovered must faster than those who did not(P < 0.01)Conclusion1.Liver injury is common during chemotherapy process in children with ALL, most of which is abnormal liver function and mild liver injury, while moderate liver injury is rare and no severe liver injury was found.2.There is a significant correlation between the incidence of liver injury following chemotherapy and age, chemotherapy stage, risk type of ALL. Liver injury occurs more in 3 to 7 years group, high doses of MTX and 6 MP and high risk type of ALL. No difference was found in the degree of liver injury.3.There is no obvious difference in the incidence of liver injury among different chemotherapy regimens, nor in the onset of liver injury.The prognosis of liver injury after chemotherapy is generally fine and protective medicine can significantly improve the cure rate of liver injury. |
PDF Full Text Request