Late hepatotoxicity after treatment for childhood cancer

Table 2 Potential late hepatic adverse effects of childhood cancer therapy

Type of cancer treatment	Potential hepatic late effects	Recommended evaluation
Thiopurines	Hepatosplenomegaly, fibrosis	ALT, AST, GGT, ALP, bilirubin, platelets
Methotrexate	Uncommon, possible fibrosis and cirrhosis	ALT, AST, GGT, ALP, bilirubin
Dactinomycin	Uncommon, possible elevations in LFTs	ALT, AST, GGT, ALP, bilirubin
Busulfan	Persistent LFTs elevation, cholestasis, hepatic fibrosis, SOS	ALT, AST, GGT, ALP, bilirubin
Oxaliplatin and cisplatin	LFTs elevation, SOS	ALT, AST, GGT, ALP, bilirubin
Docetaxel	Hepatitis/steatohepatitis, transient LFTs elevation	ALT, AST, GGT, ALP, bilirubin
Etoposide	Uncommon, possible hepatitis/steatohepatitis; cholestatic injury	ALT, AST, GGT, ALP, bilirubin
Azathioprine	Hepatic fibrosis	ALT, AST, GGT, ALP, bilirubin
Cytarabine	SOS	ALT, AST, GGT, ALP, bilirubin
Cyclophosphamide and ifosfamide	Persistent LFTs elevation	ALT, AST, GGT, ALP, bilirubin
Anthracyclines	Uncommon	ALT, AST, GGT, ALP, bilirubin
Radiation exposing liver/biliary tract	Hepatic fibrosis/cirrhosis; focal nodular hyperplasia; cholelithiasis	ALT, AST, GGT, ALP, bilirubin, prothrombin time, screen for viral hepatitis; ultrasonography
Hematopoietic stem cell transplantation	Hepatic dysfunction; hepatic fibrosis/cirrhosis; iron overload	ALT, AST, GGT, ALP, bilirubin, prothrombin time, screen for viral hepatitis; ferritin

ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; SOS: Sinusoidal obstruction syndrome; LFTs: Liver function tests.