Liver Patology in Patients with Hematological Malignancies.

BACKGROUND: Morphologic study shows liver patology in about 90% patients with hematology malignancies. Among causes of liver pathology are tumor infiltration, endogenous intoxication that follows malignancy progression, as well as cytostatic agents use. Hepatic damage of infectious etiology: bacterial, fungal and viral very often occurred due to immunosuppression and neutropenia. Besides, chronic liver diseases such as chronic viral hepatitis may contribute to toxic damage effects of antitumor drugs. Thus, there are many factors involved in liver lesions development in these patients. It is known that treatment approaches should be different depend on kind of liver lesion. Definitive identification of liver lesion etiology and mechanism can be done by liver morphological examination. At the same time morphological examination often cannot be performed in these patients because of high risk of complications. Therefore study of liver structural changes and searching of clinical criteria that associated with different pathways of liver lesions in lymphprolifirative disorders and acute leukemia are very important. Objective was to study liver lesions in lymphprolifirative disorders and acute leukemia on base of comparing clinical data with morphological examination results.

PATIENTS AND METHODS: Examinated 60 patients (male/female - 39/21): 33 - with lymphoproliferative disorders (non-Hodgkin’s lymphoma - 20, multiple myeloma - 5, Hodgkin’s lymphoma - 4, hairy cell leukaemia - 2, solitare myeloma - 1, Waldenstrom’s macroglobulinemia - 1) and 27 - with acuten leukemia (lymphoblastic leukemia/non-lymphoblastic leukemia - 11/16). The mean age was 49,7 yr (range 18 – 77). All patients received conventional chemotherapy. Liver function tests and main disease were studied. Presence chronic liver, hepatobiliary and pancreas diseases, alcoholic liver diseases were take into account. Were studied to evaluate histological features in all patients. Statistical analyses were calculated with statistical program SPSS, Version 10.0.

RESULTS: Tumor infiltration liver was revealed in 44 (73%) patients. 22 (37%) patients have demonstrated chronic viral hepatitis (HBV-infection - 5, HCV-infection - 2), alcoholic liver diseases - 5, chronic calculous and noncalculous cholecystitis - 9, chronic pancreatitis - 7. Seven patients was observed a combination of two diseases. A multifactor analysis has determined clinical syndromes that associated with tumor infiltration of liver in lymphprolifirative disorders and acute leukemia: hepatomegaly (p = 0.04, OR = 4.7, 95% CI 1.0 – 22.0), splenomegaly (p = 0.005, OR = 11.1, 95% CI 2.1 – 59.2), hemorrhagic syndrome (p = 0.02, OR = 7.5, 95% CI 1.3 – 42.3). One-sided analyses has indicated that tumor infiltration of liver is correlated with tumor intoxication (OR = 5.0, 95% CI 1.2 – 21.3), hepatocellular cholestasis (OR = 3.0, 95% CI 1.0 – 22.7), thrombocytopenia (OR = 3.4, 95% CI 1.0 – 12.4).

Multifactor analysis (logistic regression model) has revealed that presence of chronic liver diseases, is associated with elevation in serum aminotransferases (p < 0.001, OR = 11.8, 95% CI 3.4 – 41.1). HBV, HCV infection and alcoholic liver diseases were related to a more severe histological liver disease (p = 0.02, OR = 20.8, 95% CI 1.6 – 271.7).

Morphological examination indicates on severe structural hepatic changes. Combination of destructive changes of microcirculation and hepatocytes dystrophy/necrosis is evidenced about strong endogenous intoxication.