title: Liver histology after current intensified therapy for childhood acute lymphoblastic leukemia: microvesicular fatty change and siderosis are the main findings.
abstract: BACKGROUND
  During modern intensified therapy for childhood acute lymphoblastic leukemia (ALL) serum liver enzymes reach fairly high levels. Since no recent data on liver histopathology after therapy are available, we conducted a study of the subject.
  
  
  METHODS
  Liver biopsy specimens were evaluated and serum liver function tests and lipid profiles measured from 27 consecutive children, aged 3.5-17.6 years, treated according to the regimens for standard (SR) and intermediate risk (IR) ALL.
  
  
  RESULTS
  None of the patients had entirely normal liver histology. Fatty infiltration was detected in 25 out of 27 (93%) and siderosis in 19 out of 27 patients (70%). Fourteen (52%) had both. Three (11%) also had mild portal and/or periportal fibrosis in addition to fatty change and siderosis. Fatty change was mainly microvesicular. Siderosis was in most cases grade II/IV to III/IV (in 16/19 or 84%). No hepatitis or cirrhosis was found. Serum total and LDL-cholesterol levels were higher in the patients with fibrosis than in the patients with fatty change (P = 0.036, P = 0.042) or with siderosis +/- fatty change (P = 0.036, P = 0.042). In serial ALT measurements a value of 300 U/L or more was oftener reached in the fibrosis than in the fatty change or siderosis groups (in 33 vs. in 12 or in 4% of the measurements, respectively, P = 0.014, in Kruskall-Wallis test).
  
  
  CONCLUSIONS
  Microvesicular fatty change and siderosis are the main liver findings after current therapy for childhood ALL. Fibrosis occurs rarely. High values in serial serum ALT measurements repeatedly or a disturbed serum lipid profile may facilitate decisions about the need for a liver biopsy.
authors.affiliation: Paediatric Research Centre, Medical School, University of Tampere, Tampere, Finland. paivi.halonen@kotiposti.net
authors.forename: Päivi
authors.initials: P
authors.lastname: Halonen
authors.forename: Jorma
authors.initials: J
authors.lastname: Mattila
authors.forename: Tarja
authors.initials: T
authors.lastname: Ruuska
authors.forename: Matti K
authors.initials: MK
authors.lastname: Salo
authors.forename: Anne
authors.initials: A
authors.lastname: Mäkipernaa
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury; D002648:Child; D002675:Child, Preschool; D005234:Fatty Liver / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000473:pathology; D008107:Liver Diseases / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012806:Siderosis / Q000209:etiology* / Q000473:pathology
chemical_list: D000410:Alanine Transaminase