Baseline Liver Function Abnormalities in Children with Acute Lymphoblastic Leukemia before Chemotherapy: Clinical and Prognostic Correlations

Background: Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy, and although survival has improved with modern chemotherapy, hepatotoxicity remains a significant concern. Baseline liver function abnormalities, even before treatment, may complicate therapy, increase the risk of hepatotoxicity, and influence clinical outcomes. Early assessment of liver enzymes allows for risk stratification, supportive care, and tailored chemotherapy regimens. Understanding the prevalence and clinical significance of baseline liver dysfunction in children with ALL is essential to optimizing treatment safety and reducing therapy-related complications. Aim of the Study: This study aims to evaluate baseline liver function abnormalities in children diagnosed with acute lymphoblastic leukemia (ALL) before the initiation of chemotherapy and to assess their clinical and prognostic correlations with treatment outcomes. Methods: This prospective observational study was conducted at the Paediatric Haematology and Oncology Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2002 to August 2003. Thirty children aged 0–15 years with newly diagnosed ALL confirmed by bone marrow and peripheral blood film were enrolled. Baseline demographic, clinical, and laboratory data, including comprehensive liver function tests (LFTs), were recorded. Follow-up LFTs were performed at key treatment stages. Data were analyzed in SPSS using descriptive statistics, correlation, and logistic regression to identify predictors of baseline LFT abnormalities (p<0.05). Results: Among 30 children with ALL (90% aged 2–10 years; 60% male), common symptoms included anorexia and fatigue (100%), fever (90%), and irritability (70%). Clinical signs included anemia (80%), hepatomegaly (70%), lymphadenopathy (60%), and splenomegaly (50%). Nearly half (46.7%) had 1st-degree malnutrition. Baseline liver function was essentially normal, with only ALT elevated in 20% and bilirubin in 6.7%; AST, ALP, albumin, and PT remained normal. Hepatomegaly was a significant predictor of baseline LFT abnormalities (OR 4.12, p=0.042), while malnutrition showed a trend toward association. ALT and bilirubin correlated with hepatomegaly, and higher ALT was linked with poor nutrition, anemia, and thrombocytopenia. Conclusion: Baseline liver function is generally preserved in pediatric ALL, with only mild ALT and bilirubin elevations. Hepatomegaly predicts LFT abnormalities, while malnutrition, anemia, and thrombocytopenia show weaker associations. Significant hepatic dysfunction at diagnosis is uncommon and rarely delays chemotherapy. Routine baseline LFTs remain important to identify at-risk children and guide supportive care, particularly in malnourished or clinically vulnerable patients.