Levocarnitine for asparaginase-induced hepatic injury: a multi-institutional case series and review of the literature. Leuk Lymphoma 2018 Oct;59(10):2360-2368
Date
02/13/2018Pubmed ID
29431566Pubmed Central ID
PMC10183102DOI
10.1080/10428194.2018.1435873Scopus ID
2-s2.0-85041894381 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
Asparaginase, an important treatment component for acute lymphoblastic leukemia (ALL), causes severe hepatotoxicity in some patients. Levocarnitine is a mitochondrial co-factor that can potentially ameliorate the mitochondrial toxicity of asparaginase. In this retrospective case series, we describe the clinical presentation and management of six pediatric and young adult patients (mean age 12.7, range 9-24 years) with ALL who developed Grade 3-4 hyperbilirubinemia following administration of asparaginase as part of induction/re-induction therapy. Five of these patients were treated with levocarnitine with subsequent improvement of hyperbilirubinemia, while one patient was given levocarnitine prophylactically during induction and developed Grade 3 hyperbilirubinemia, but did not require therapy adjustments or delays. Increased awareness in the pediatric oncology community regarding asparaginase-associated hepatic toxicity and the potential role of levocarnitine in management is warranted.
Author List
Schulte RR, Madiwale MV, Flower A, Hochberg J, Burke MJ, McNeer JL, DuVall A, Bleyer AAuthor
Michael James Burke MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAntineoplastic Combined Chemotherapy Protocols
Asparaginase
Carnitine
Chemical and Drug Induced Liver Injury
Child
Female
Humans
Hyperbilirubinemia
Liver
Liver Function Tests
Male
Polyethylene Glycols
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Remission Induction
Treatment Outcome
Ultrasonography
Young Adult
