Suzuki Ryoko, Kobayashi Chie, Sakai Aiko, Fukushima Hiroko, Tagawa Manabu, Satomi Kaishi, Nanmoku Toru, Sumazaki Ryo, Fukushima Takashi
*Department of Child Health, Graduate School of Comprehensive Human Sciences, University of Tsukuba Departments of †Child Health ‡Pathology, Faculty of Medicine §Clinical Laboratory, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
J Pediatr Hematol Oncol. 2015 Aug;37(6):e368-71. doi: 10.1097/MPH.0000000000000337.
Imatinib mesylate has dramatically improved the outcome of children with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph* ALL) and is now included as first-line therapy. Uncommon adverse effects of this drug for pediatric use, however, are largely unknown. We report the first case of a 9-year-old child who developed severe acute hepatitis with grade 4 transaminases and bilirubin elevation during imatinib treatment for Ph* ALL. Liver biopsy showed extensive lobular and pericentral necrosis of hepatocytes. Liver function recovered after discontinuing imatinib with a 4-week prednisolone. Extensive hepatic necrosis should be considered not only in adults but also in children under imatinib administration.
甲磺酸伊马替尼显著改善了费城染色体阳性急性淋巴细胞白血病（Ph+ ALL）患儿的治疗结果，现已被纳入一线治疗方案。然而，这种药物在儿科使用中罕见的不良反应在很大程度上尚不清楚。我们报告了首例9岁儿童，该患儿在接受甲磺酸伊马替尼治疗Ph+ ALL期间出现严重急性肝炎，转氨酶和胆红素升高至4级。肝活检显示肝细胞广泛的小叶和中央周围坏死。停用甲磺酸伊马替尼并使用泼尼松龙治疗4周后肝功能恢复。不仅在成人中，而且在接受甲磺酸伊马替尼治疗的儿童中，都应考虑广泛的肝坏死。
