Acute myeloid leukemia presenting with hepatic dysfunction: Should induction be dose reduced?

EJHaem Pub Date : 2024-08-07 DOI:10.1002/jha2.979
Satish Maharaj, Simone Chang
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Abstract

The combination of de novo hepatic dysfunction and AML in a medically fit patient presents an unusual predicament. Cases present with obstructive jaundice and imaging typically shows diffuse hepatosplenomegaly, with some cases visualizing myeloid sarcomas causing biliary ductal dilatation. Guidelines for use of anthracyclines in hepatic dysfunction recommend dose reduction based on bilirubin blood levels, either to 50% or even omitting anthracycline. Randomized data however has shown that reduction of anthracycline in AML induction decreases overall survival and lowers remission rate. This case suggests, along withthe literature reviewed, that some medically fit patients with hepatic dysfunction benefit from and tolerate intensive induction therapy well without toxicity.

Abstract Image

急性髓性白血病伴有肝功能障碍:是否应减少诱导剂量?
一个身体健康的病人同时患有新发肝功能异常和急性髓细胞白血病,这是一种不寻常的困境。病例表现为梗阻性黄疸,影像学典型表现为弥漫性肝脾肿大,部分病例可见髓样肉瘤导致胆管扩张。肝功能障碍患者使用蒽环类药物的指南建议根据胆红素血药浓度减少剂量,可减少至 50%,甚至不使用蒽环类药物。但随机数据显示,在急性髓细胞白血病诱导治疗中减少蒽环类药物的剂量会降低总生存率和缓解率。本病例以及所查阅的文献表明,一些肝功能不全的病人可以从强化诱导治疗中获益,并能很好地耐受强化诱导治疗而不产生毒性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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