Liver involvement in pediatric acute leukemia: subtype differences and complex hepatic injury as a novel marker for AML risk stratification.
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OBJECTIVES: This study aimed to investigate the prevalence, pattern of liver involvement at diagnosis of pediatric acute leukemia, and its associations with clinical features and prognosis. METHODS: From January 2016 to December 2017, 304 consecutive children newly diagnosed with acute leukemia (190 pre-B acute lymphoblastic leukemia (ALL), 25 T-ALL, and 89 acute myeloid leukemia (AML)), were enrolled. Liver involvement was defined as hepatomegaly (HM), hepatocellular injury (HI), hepatic dysfunction (HD) and cholestasis. RESULTS: The prevalence of liver involvement varied significantly across leukemia subtypes: T-ALL (80.0%), pre-B-ALL (64.0%), and AML (37.0%) (P<0.001). HM was the most common isolated manifestation in all subtypes. Lower platelet counts were significantly associated with HM and HI in pre-B-ALL, and with HD in T-ALL (all P < 0.05). HI was positively correlated with age in pre-B-ALL (median age: 9.0 vs. 4.0 years, P < 0.001), while HM was associated with higher white blood cell (WBC) counts in T-ALL (228.0 vs. 10×109/L, P = 0.035). HD showed a trend of association with elevated WBC counts in AML (P = 0.054). Liver involvement was not associated with early treatment response or long-term survival in ALL. In AML, however, complex hepatic injury and WBC count emerged as independent adverse prognostic factors: AML patients without liver involvement had the best 5-year overall survival (OS: 87.5 ± 4.4%) and event-free survival (EFS: 80.4 ± 5.3%), whereas those with complex hepatic injury had the poorest outcomes (5-year OS: 58.3 ± 14.2%, EFS:50.0 ± 14.4%). CONCLUSIONS: Liver involvement exhibits subtype-specific patterns in pediatric acute leukemia and is associated with age, WBC and platelet counts. Notably, complex hepatic injury may serve as a potential adverse prognostic marker for pediatric AML.