title: Hepatic dysfunction as the presenting feature of acute lymphoblastic leukemia.
abstract: OBJECTIVE
  Hepatic dysfunction is a rare presentation of leukemia in children. Because most chemotherapy agents are metabolized by the liver, this complication may have major adverse consequences and effective treatment could be compromised.
  
  
  METHODS
  The MEDLINE database and current management guidelines from the United States Pediatric Cooperative Cancer Groups were reviewed and analyzed. Data from two institutional cases are described.
  
  
  RESULTS
  Although previous literature is not informative, our experience suggests that children with leukemia and moderate hepatic dysfunction may tolerate aggressive chemotherapy.
  
  
  CONCLUSIONS
  Current protocol guidelines for dose modification for liver disease may be overly stringent and modification may be beneficial.
authors.affiliation: Department of Pediatrics, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Kelleher
authors.forename: P M
authors.initials: PM
authors.lastname: Monteleone
authors.forename: D A
authors.initials: DA
authors.lastname: Steele
authors.forename: D L
authors.initials: DL
authors.lastname: Gang
authors.forename: A G
authors.initials: AG
authors.lastname: Angelides
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000493:pharmacokinetics / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000493:pharmacokinetics; D001706:Biopsy; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000209:etiology* / Q000473:pathology; D002872:Chromosome Deletion; D003630:Daunorubicin / Q000008:administration & dosage / Q000493:pharmacokinetics; D006529:Hepatomegaly / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012074:Remission Induction; D013921:Thrombocytopenia / Q000209:etiology; D014463:Ultrasonography; D014750:Vincristine / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D014750:Vincristine; D015122:Mercaptopurine; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate; D003630:Daunorubicin