Hepatic dysfuction is one of the most commonly encountered problems in the treatment of children with malignancies. In order to determine the adverse factors on hepatic injury, one hundred and forty-seven patients with various childhood
malignancies
were studied. The patients were divided into two groups: Group 1, eighty-six with elevated serum alanine aminotransferase(s-ALT); Group 2, sixty-one with normal s-ALT. They were compared with regard to the laboratory characteristics, transfusion
history, post-transfusion hepatitis B (HbsAg) and C(anti-HCV) markers, as well as the chemotherapeutic agents used.
Patients in Group 1 received more transfusion than those in Group 2 because of low platelet and hemoglobin counts at diagnosis(P<0.01), but as much as 41% of transfused patients in Group 1 showed no causal time-relationship between transfusion
and
elevation of s-ALT, and slso, only one case was positive for anti-HCV. Though eight patients in Group 1 were positive for HBsAg, only 3 patients became positive for HBsAg after transfusion. Considering the situation in Group 1, we suggest that
elevated
s0ALT caused by transfusion-associated viral infections may not be the chief factor causing hepatotoxicity.
In group 1, chemotherapeutics like methotrexate, 6-mercaptopurine, L-asparaginase, cytarabine, vincristine, daunomycin, and cyclophosphamide were found to be associated with S-ALT elevation in more than half patients administerd.
Accordingly, we concluded that anticancer agents played the most important role in causing the elevation of s-ALT in children with malignancy rather than transfusion-associated factors. Further evaluation not only for the transfusion-related
viral
hepatitis, such as Hepatitis C virus with better screening methods, cytomegalovirus, and Epstein-Barr virus, but also for other possible factors, not studied here is still required in larger, prospective study.
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