title: Chemotherapy dosing with elevated liver function test results in acute leukemia.
abstract: OBJECTIVE
  To report a case of massive blast infiltration of the liver by acute lymphoblastic leukemia (ALL) manifested by worsening liver function test (LFT) results and concern over how to dose chemotherapy in this patient.
  
  
  METHODS
  A 36-year-old male presenting with productive cough, abdominal pain, and lower back pain was diagnosed with pre-B cell ALL. Of note, the patient developed worsening LFT results within the first few days of diagnosis. Because of concern over increasing liver dysfunction and the need to administer vincristine and daunorubicin with induction therapy, a transvenous liver biopsy was performed, revealing massive lymphoblast infiltration.
  
  
  CONCLUSIONS
  A short course of prednisone was given to determine whether the LFT abnormalities would reverse with treatment. Once a downward trend in the abnormalities was noted, full-dose induction chemotherapy was administered.
  
  
  CONCLUSIONS
  It is important to discern the cause of elevated LFT values in patients with acute leukemia who require induction chemotherapy, as this may affect treatment decisions and patient outcomes.
authors.affiliation: Bone Marrow and Stem Cell Transplantation Program, Division of Hematology and Medical Oncology, School of Medicine, The University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Terrance B
authors.initials: TB
authors.lastname: Comeau
authors.forename: Debra L
authors.initials: DL
authors.lastname: Phillips
mesh_terms: D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000503:physiopathology; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D011241:Prednisone; D003630:Daunorubicin