Summary
Eight of 36 children receiving maintenance chemotherapy for acute lymphoblastic leukaemia or non-Hodgkin's lymphoma had liver biopsies on the basis of clinical abnormalities and/or elevated serum enzyme levels. Six biopsies were abnormal, including one in a boy with spider naevi who showed micronodular cirrhosis; he appeared to retain methotrexate in the blood for a prolonged period and his SGOT level did not return to normal for 19 months after maintenance chemotherapy was discontinued. The five other abnormal biopsies showed minor changes in the portal tracts. The six children with abnormal liver histology showed a wide variation in their early handling of an oral methotrexate dose.
There was a statistically significant rise in mean SGOT and alkaline phosphatase during treatment, but the wide scatter in values precluded their use as accurate indicators of liver damage in these children.
Similar content being viewed by others
References
Bergsagel DE, Levin WC (1960) A prelusive clinical trial of cyclophosphamide. Cancer Chemother Rep 8:120
Clark PA, Hsia YE, Huntsman RG (1960) Toxic complications of treatment with 6-mercaptopurine. Br Med J 1:393
Colsky J, Greenspan EM, Warren TN (1955) Hepatic fibrosis in children with acute leukaemia after treatment with folic acid antagonists. Arch Pathol 59:198
Craft AW, Rankin AJ, Aherne W (1980) Cancer treatment reports (in press)
Dubin HV, Harrell ER (1969) Absorption of methotrexate and hepatotoxicity. JAMA 210:1104
Einhorn M, Davidsohn I (1964) Hepatotoxicity of mercaptopurine. JAMA 188:802
Hersch EM, Wong VG, Henderson ES, Freireich EJ (1966) Hepatotoxic effects of methotrexate. Cancer 19:600
Hutter RVP, Shipkey FH, Tan CTC, Murphy ML, Chowdhury M (1960) Hepatic fibrosis in children with acute leukaemia. Cancer 13:288
Lascari AD (1973) Leukaemia in childhood. Thomas, Illinois, NJ, p 408
McIlvanie SK, MacCarthy JD (1959) Hepatitis in association with prolonged 6-mercaptopurine therapy. Blood 14:80
McIntosh S, Davidson DL, O'Brien RT, Pearson HA (1977) Methotrexate hepatotoxicity in children with leukemia. J Pediatr 90:1019
Nesbit M, Krivit W, Heyn R, Sharp H (1976) Acute and chronic effects of methotrexate on hepatic pulmonary and skeletal systems. Cancer 37:1048
Nyfors A (1977) Liver biopsies from psoriatics related to methotrexate therapy, 3. Acta Pathol Microbiol Scand [A] 85:511
Nyfors A, Poulsen H (1976) Liver biopsies from psoriatics related to methotrexate therapy (2). Acta Pathol Microbiol Scand [A] 84:262
Round JM (1973) Plasma calcium, magnesium, phosphorus and alkaline phosphatase levels in normal British schoolchildren. Br Med J 3:137
Ruymann FB, Mosijczuk AD, Sayers RJ (1977) Hepatoma in a child with methotrexate-induced hepatic fibrosis. JAMA 238:2631
Searcy RL (1969) Diagnostic biochemistry. McGraw-Hill, New York, p 513
Taft LI (1965) Methotrexate induced hepatitis in childhood leukaemia. Isr J Med Sci 1:823
Wetherley-Mein G, Cottom DG (1956) Portal fibrosis in acute leukaemia. Br J Haematol 2:345
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Parker, D., Bate, C.M., Craft, A.W. et al. Liver damage in children with acute leukaemia and non-Hodgkin's lymphoma on oral maintenance chemotherapy. Cancer Chemother. Pharmacol. 4, 121–127 (1980). https://doi.org/10.1007/BF00254033
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00254033