Adverse prognostic influence of hepatitis B virus infection in acute lymphoblastic leukemia.
Liver function test abnormalities were examined in a retrospective survey in a population of 90 children with acute lymphoblastic leukemia (ALL) treated in a similar fashion with therapy, using primarily methotrexate, mercaptopurine, vincristine, and prednisone. A twofold or greater elevation of serum glutamyl pyruvic transaminase (SGPT) was found in 80% of the patients during induction therapy, in 63% of the patients during maintenance therapy, and 31% of the patients who completed therapy. Circulating hepatitis B virus surface antigen (HBsAg) was noted in 26% of patients with liver function test abnormalities during maintenance therapy, and 45% of patients with liver function test abnormalities after the completion of therapy. Hepatitis B virus infection was therefore, the most important single cause of abnormal liver function during remission in our patient population. Though others have asserted that hepatitis B virus infection is relatively benign in immunosuppressed individuals, in our population, this agent often caused severe pathological and clinical sequelae. This may be related to the high frequency (50%) of co-infection with the delta agent in our HBsAg-positive patients. Furthermore, hepatitis B virus surface antigenemia conferred an adverse prognostic influence for these children in terms of their leukemia-free survival.
Ratner
L
L
Peylan-Ramu
N
N
Wesley
R
R
Poplack
D G
DG
D000208:Acute Disease; D000410:Alanine Transaminase / Q000032:analysis; D001219:Aspartate Aminotransferases / Q000032:analysis; D002648:Child; D006509:Hepatitis B / Q000150:complications* / Q000382:microbiology; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D007945:Leukemia, Lymphoid / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008099:Liver / Q000201:enzymology; D011379:Prognosis
D006514:Hepatitis B Surface Antigens; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase