Hepatic late effects are not commonly reported in survivors of childhood leukemia. Four young male patients with acute lymphoblastic leukemia (ALL) were diagnosed with bleeding esophageal varices (EVs) during or shortly after completion of maintenance chemotherapy. EVs were identified from 0 to 60 months after completion of leukemia therapy. All four patients were men between 20 to 24 years old. Hematemesis was the most common presenting symptom. Associated features included splenomegaly, cytopenias, azole therapy, alcohol use, and hepatic iron overload. EVs may be an under-recognized complication of ALL therapy, with adolescent and young adult males at highest risk.
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References
1.
HungerSP, MullighanCG. Acute lymphoblastic leukemia in children. N Engl J Med. 2015; 373(16):1541–52.
SchultzKR, PullenDJ, SatherHN, et al.Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia: a combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG). Blood. 2007; 109(3):926–35.
4.
DonadieuJ, AuclercMF, BaruchelA, et al.Prognostic study of continuous variables (white blood cell count, peripheral blast cell count, haemoglobin level, platelet count and age) in childhood acute lymphoblastic leukaemia. Analysis Of a population of 1545 children treated by the French Acute Lymphoblastic Leukaemia Group (FRALLE). Br J Cancer. 2000; 83(12):1617–22.
5.
ShusterJJ, WackerP, PullenJ, et al.Prognostic significance of sex in childhood B-precursor acute lymphoblastic leukemia: a Pediatric Oncology Group Study. J Clin Oncol. 1998; 16(8):2854–63.
6.
GoldsbyR, ChenY, RaberS, et al.Survivors of childhood cancer have increased risk of gastrointestinal complications later in life. Gastroenterology. 2011; 140(5):1464–71. e1461.
7.
AsdahlPH, WintherJF, BonnesenTG, et al.Gastrointestinal and liver disease in Adult Life After Childhood Cancer in Scandinavia: a population-based cohort study. Int J Cancer. 2016; 139(7):1501–11.
8.
StorkLC, MatloubY, BroxsonE, et al.Oral 6-mercaptopurine versus oral 6-thioguanine and veno-occlusive disease in children with standard-risk acute lymphoblastic leukemia: report of the Children's Oncology Group CCG-1952 clinical trial. Blood. 2010; 115(14):2740–48.
9.
RawatD, GillettPM, DevadasonD, et al.Long-term follow-up of children with 6-thioguanine-related chronic hepatoxicity following treatment for acute lymphoblastic leukaemia. J Pediatr Gastroenterol Nutr. 2011; 53(5):478–9.
10.
De BruyneR, PortmannB, SamynM, et al.Chronic liver disease related to 6-thioguanine in children with acute lymphoblastic leukaemia. J Hepatol. 2006; 44(2):407–10.
11.
BroxsonEH, DoleM, WongR, et al.Portal hypertension develops in a subset of children with standard risk acute lymphoblastic leukemia treated with oral 6-thioguanine during maintenance therapy. Pediatr Blood Cancer. 2005; 44(3):226–31.
12.
RavikumaraM, HillFG, WilsonDC, et al.6-Thioguanine-related chronic hepatotoxicity and variceal haemorrhage in children treated for acute lymphoblastic leukaemia—a dual-centre experience. J Pediatr Gastroenterol Nutr. 2006; 42(5):535–8.
13.
StonehamS, LennardL, CoenP, et al.Veno-occlusive disease in patients receiving thiopurines during maintenance therapy for childhood acute lymphoblastic leukaemia. Br J Haematol. 2003; 123(1):100–2.
14.
BozicMA, PuriK, MollestonJP. Screening and prophylaxis for varices in children with liver disease. Curr Gastroenterol Rep. 2015; 17(7):27.
15.
FagundesED, FerreiraAR, RoqueteML, et al.Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome. J Pediatr Gastroenterol Nutr. 2008; 46(2):178–83.
16.
FerlitschA, TemlA, ReinischW, et al.6-thioguanine associated nodular regenerative hyperplasia in patients with inflammatory bowel disease may induce portal hypertension. Am J Gastroenterol. 2007; 102(11):2495–503.
17.
Vernier-MassouilleG, CosnesJ, LemannM, et al.Nodular regenerative hyperplasia in patients with inflammatory bowel disease treated with azathioprine. Gut. 2007; 56(10):1404–9.
18.
PuiCH, BoyettJM, RellingMV, et al.Sex differences in prognosis for children with acute lymphoblastic leukemia. J Clin Oncol. 1999; 17(3):818–24.
19.
MorickeA, ReiterA, ZimmermannM, et al.Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood. 2008; 111(9):4477–89.
20.
RuccioneKS, WoodJC, SpostoR, et al.Characterization of transfusion-derived iron deposition in childhood cancer survivors. Cancer Epidemiol Biomarkers Prev. 2014; 23(9):1913–19.
21.
BravoR, Pelayo-KatsanisLO, ShehabZM, KatsanisE. Diagnostic and treatment challenges for the pediatric hematologist oncologist in endemic areas for coccidioidomycosis. J Pediatr Hematol Oncol. 2012; 34(5):389–94.
