title: L-Carnitine for Treatment of Pegasparaginase-Induced Hepatotoxicity.
abstract: Similar to pediatric regimens, multiple doses of L-asparaginase (PEG-Asp) are being increasingly used in adults with newly diagnosed acute lymphoblastic leukemia (ALL) with promising results. One of the most common side effects of the drug in adults is high-grade hyperbilirubinemia and transaminitis. Despite being almost always reversible and may not recur, clinicians may still be reluctant to continue with PEG-Asp in patients with liver toxicity, losing the benefit from multiple doses of the drug.
  
  
  
  We describe a case of adult ALL who developed PEG-Asp-related high grade liver toxicity. The rising hyperbilirubinemia and transaminitis rapidly and permanently reversed using the amino-acid derivative L-carnitine. This case goes in line with similar observations in animal models and humans.
  
  
  
  L-Carnitine may show therapeutic benefit in PEG-Asp-related hepatotoxicity and should be considered in clinical trials of the drug.
authors: Memorial Sloan Kettering Cancer Center, New York, N.Y., USA.
authors: Ruham
authors: R
authors: Alshiekh-Nasany
authors: Dan
authors: D
authors: Douer
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents; D000971:Antineoplastic Combined Chemotherapy Protocols; D001215:Asparaginase; D002331:Carnitine / Q000627:therapeutic use*; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D011092:Polyethylene Glycols; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis; D012008:Recurrence
chemical_list: D000970:Antineoplastic Agents; D011092:Polyethylene Glycols; D001215:Asparaginase; D002331:Carnitine