Evaluation of hepatotoxicity due to conditioning regimens in beta thalassemia major and aplastic anemia patients undergoing bone marrow transplantation

Abstract

Introduction

Conditioning regimen-related hepatotoxicity is one of the frequent causes of morbidity and mortality in hematological disorder patients undergoing bone marrow transplantation—the current study aimed to evaluate the effects of conditioning regimens on liver enzymes.

Methods

This observational analytical study was conducted for one year and recruited patients who received conditioning regimens before undergoing Bone Marrow Transplantation for benign hematological disorder [aplastic anemia (AA) and beta-thalassemia major (BTM)]. Pre-and post-transplant assessment particularly liver function test was done. End point was abnormality in biochemical parameters due to conditioning regimens.

Results

A total of 53 patients (aplastic anemia = 23 and beta thalassemia major = 30), 58% were males and 85% were <16 years of age. Significant differences in serum glutamic pyruvic transaminase (SGPT) and alanine aminotransferase (ALT) were observed before and during treatment. Overall survival in AA and BTM patients was 100% and 90% respectively. Liver injury (total bilirubin ≥2 Grade) was observed in 9.4% [n = 5 (AA = 2 and BTM = 3)] patients. VOD was observed in one BTM patient. All of them had received a Cyclophosphamide (Cy) based conditioning regimen. Of the 49 patients receiving a Cy-based conditioning regimen, 10.2% of which one patient expired.

Conclusion

Despite being significant, hepatotoxicity due to the rise in SGPT and ALT was transient in BTM and AA patients taking the Cy-based conditioning regimen in our cohort. This evidence needs to be further evaluated by conducting studies over a larger scale and conducting liver profiles as regular biochemical profiles of transplant patients in both pre- and post-transplant periods.