Prospective analysis reveals HDMTX-related hepatotoxicity in children, indicating the need for liver monitoring and support.
Background: High-dose methotrexate (HDMTX) is essential in pediatric acute lymphoblastic leukemia (ALL) treatment, but its hepatotoxic effects, especially in resource-limited settings, require further evaluation. The current study aimed to assess liver function changes across chemotherapy phases, with emphasis on HDMTX-induced hepatotoxicity and recovery trends in Bangladeshi children with ALL. Methods: This prospective study was conducted at the Paediatric Haematology and Oncology Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Thirty (30) children aged 2–15 years undergoing ALL chemotherapy. Liver function tests (LFTs) were evaluated at four points: baseline, post-induction, post-HDMTX, and after 3-month maintenance. Results: Baseline LFTs were mostly normal. Post-induction, mild ALT elevation was seen in 30%, with bilirubin elevated in 16.7%. Following HDMTX, ALT, AST, and ALP were elevated in 70% of cases, while bilirubin rose to 30%. No abnormalities were seen in albumin or prothrombin time at any stage. At 3-month follow-up, liver enzymes had largely normalized: ALT (86.7%), bilirubin (93.3%), and AST/ALP (100%). Conclusion: HDMTX-induced hepatotoxicity is common but transient, with full recovery in most cases. Regular monitoring and supportive care can mitigate risks, even in low-resource settings.
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Rahman et al. (2020) studied this question.