Booklet for Hemato-Oncologists
Case 10 (A, B) - Increase of serum AST and ALT during maintenance therapy with 6-MP and MTX
Female, 10 years old, affected by common ALL. During maintenance while receiving oral 6-MP and MTX she developed a 15-fold increase of serum AST and ALT with normal bilirubin level.
A - How do you modify the chemotherapy?
1. Immediately discontinue chemotherapy and re-check liver function
2. Monitor liver enzymes without stopping therapy
3. Rule out viral hepatitis
4. Perform liver biopsy to determine the histological extend of the liver disease
5. If liver function doesn't show any further increase, either if enzymes level is high, restart gradually the drugs.
B - Which drugs have to be held when such a liver toxicity occurs?
5. All the above
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