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L-carnitine and Vitamin B Complex for PEG-L-asparaginase-Induced Hepatotoxicity
Journal article   Open access   Peer reviewed

L-carnitine and Vitamin B Complex for PEG-L-asparaginase-Induced Hepatotoxicity

Sumant Arora, Jagpal Klair, Andrew M Bellizzi and Tomohiro Tanaka
ACG case reports journal, Vol.6(8), p.e00194
2019
DOI: 10.14309/crj.0000000000000194
PMCID: PMC6791645
PMID: 31737724
url
https://doi.org/10.14309/crj.0000000000000194View
Published (Version of record) Open Access

Abstract

Asparaginase is a part of combination chemotherapy for acute lymphoblastic leukemia. We present a 58-year-old woman with refractory acute lymphoblastic leukemia who developed asparaginase-induced hepatotoxicity after receiving intravenous PEG-L-asparaginase-based chemotherapy. The patient presented with hyperbilirubinemia and transaminitis. The patient was diagnosed with drug-induced liver injury due to PEG-L-asparaginase after a thorough evaluation for all other causes and received treatment with L-carnitine and vitamin B complex with normalization of liver numbers. Hepatic dysfunction was attributed to depletion of L-asparagine and glutamine, which impairs mitochondrial β-oxidation and induces steatosis. We reiterate the role of L-carnitine and vitamin B complex for the treatment of asparaginase-induced hepatotoxicity. © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

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