Evaluating the risk factors for liver injury in patients with chronic lymphocytic leukemia in the dynamics of chemotherapy
Background. B-cell chronic lymphocytic leukemia (B-CLL) treatment is accompanied by a risk of liver injury due to factors that depend on the characteristics of the patient, tumor, and chemotherapy (CT). The purpose was to assess the risk of development and nature of liver injury in patients with B-CLL in the dynamics of CT. Materials and methods. Seventy-six patients with В-CLL were examined, including 44 (57.9 %) men and 32 (42.1 %) women. The average age was (66.81 ± 12.50) years. The B-CLL stage was determined according to the Rai (1975, 1987) and Binet (1981, 2006) classifications. CT was administered in FC (fludarabine, cyclophosphamide) regimen. The patients were examined twice: before CT and after two FC courses. Hyperplastic syndrome and hyperleukocytosis were taken into account. Biochemical blood tests were evaluated. Common Terminology Criteria for Adverse Events, version 4.02, were used. Results. Advanced B-CLL stages (stage IV (C) according to Rai, Binet) are associated with an increased risk of no response on CT (risk ratio (RR) = 0.53; 95% confidence interval (CI) = 0.31–0.90; p < 0.05). The presence of hyperplastic syndrome is accompanied by a significant risk of no response on CT (RR = 0.23; 95% CI = 0.07–0.80; p < 0.05). Liver injury is more often detected in patients with B-CLL stages III (RR = 1.96; 95% CI = 1.33–2.88; p < 0.05) and IV (RR = 2.13; 95% CI = 1.47–3.08; p < 0.05) versus stage II by Rai. In patients with B-CLL, the risk of hepatotoxic reactions development is associated with low efficacy of CT, namely the achievement of partial response (RR = 3.18; 95% CI = 1.93–5.22; p < 0.05) and no response on CT (RR = 3.71; 95% СІ = 2.37–5.81; р < 0.05). Conclusions. The risk of liver injury increases in patients with B-CLL stage IV (C) and is associated with low CT efficacy.
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