Liver Fibrosis Screening in Childhood Acute Lymphoblastic Leukemia Survivors by Transient Elastography: A Case-Control Study.

Abstract

Objectives: Clinical and biochemical screening is recommended to monitor hepatobiliary late-effects in childhood acute lymphoblastic leukemia survivors (cALLs). Transient elastography (TE) noninvasively evaluates liver fibrosis by measuring liver stiffness (LSM) with good sensitivity. We screened cALLs for high-LSM using TE, comparing them to controls and evaluated risk factors for high-LSM.

Methods: This case-control study included cALLs who were under 18 years at diagnosis, had completed therapy between 2016 and 2023, and were at least 6-months post-completion of therapy. This study also included 50 age- and sex-matched controls. TE (Fibroscan®) was used for LSM, with cutoff ≥ 5.1 kPa for high-LSM indicating fibrosis, and for controlled attenuation parameter (CAP), with cutoff > 248 dB/m for steatosis.

Results: Fifty-eight cALLs with mean (SD) age of 136.58 (58) months at enrollment were analyzed after mean (SD) duration of 27 (8) months post-completion of therapy. High-LSM was observed in 22/58 (37.9%) of cases. The number of children with high-LSM in cALLs (22/58) compared to control group (8/50) was significantly higher (P = 0.011). In univariate analysis, age at diagnosis ≥ 5 years, bilirubin > 1 mg/dl, and alanine transaminase (ALT) ≥ 40 U/L, while in multivariate analysis ALT ≥ 40 U/L, were found to be associated with high-LSM. Mean (SD) CAP measurement in cALLs was 192 (56) dB/m. Steatosis was seen in 11/58 (18.9%) cases. CAP had a positive correlation with serum triglycerides and cholesterol levels, and a negative correlation with adiponectin levels.

Conclusion: We report a high prevalence of high-LSM (≥ 5.1 kPa) among cALLs, which indicates liver fibrosis. ALT ≥ 40 U/L was a significant predictor of hepatic fibrosis in cALLs. TE is a useful tool for evaluating hepatobiliary late-effects in cALLS.