title: Successful use of high-dose cytarabine in a patient with acute myeloid leukemia and severe hepatic dysfunction.
abstract: Acute myeloid leukemia is a hematologic malignancy characterized by the clonal expansion of myeloid blasts in the peripheral blood, bone marrow, and other tissues. Prognosis is poor with 5-year survival rates ranging from 5-65% depending on demographic and clinical features. Outcomes are worse for patients that have an antecedent myeloproliferative neoplasm that evolves to acute myeloid leukemia, with a survival rate of <10%. Treatment for acute myeloid leukemia has remained cytarabine and an anthracycline given in the standard 3 + 7 regimen. However, for patients with liver dysfunction this regimen, among many others, cannot be given safely. There is currently a lack of data regarding the use of cytarabine in patients with severe hepatic dysfunction. In this case report, we present a patient with secondary acute myeloid leukemia who successfully received a modified regimen of high-dose cytarabine while in severe hepatic dysfunction (bilirubin >15 mg/dL).
authors.affiliation: Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Barker
authors.affiliation: Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Marini
authors.affiliation: Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Bixby
authors.affiliation: Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA ajperis@med.umich.edu.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perissinotti
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D003561:Cytarabine / Q000008:administration & dosage*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008107:Liver Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine
keywords: Acute myeloid leukemia; cytarabine; hepatic dysfunction