Children with acute lymphoblastic leukemia (ALL) are primarily treated by chemotherapeutic regimens consisting of combinations of various drugs. All patients undergoing chemotherapy experience unwanted side effects. To some extent, these side effects are due to drug catalysis of deamination. The purpose of the present study was to evaluate the relationship between changes in plasma amino acids and adverse events after chemotherapy for childhood ALL.
Data for 10 children who were diagnosed with ALL in 2010 were reviewed retrospectively. All patients had undergone chemotherapy according to agreed national protocols. Plasma amino acid levels were measured on the first day of chemotherapy and again 8-10 days after each course of treatment. Adverse events were defined on the basis of subjective/objective symptoms and laboratory data according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (NCI-CTCAE v3.0). Data were analyzed by paired t-test, multivariate analysis, and ANCOVA. P<0.05 was considered significant.
Grade 3 or higher adverse events were not observed for any clinical symptoms. However, all 10 children were found to have Grade 3 adverse events in terms of laboratory data, including leukopenia (n=9), granulocytopenia (n=10), anemia (n=5), thrombocytopenia (n=4), and increases in aspartate aminotransferase (AST;n=3) and alanine minotransferase (n=4). Reductions in plasma glutamine, citrulline, and arginine levels were noted after chemotherapy. There was a strong tendency for the interaction between methionine andarginine levels to affect the AST grade.
The present study is an exploratory study with a small sample size. Further studies are needed in a larger population.

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[Introduction]Amino acids such as branched-chain amino acids (BCAA) are usually administered to chronic liver failure patients, but their administration is not recommended in acute liver failure patients. However, few reports have investigated the change in the plasma concentration of amino acids in acute hepatic failure patients in detail.
[Purpose]To evaluate plasma amino acid levels in acute hepatic failure.
[Materials and Methods]We retrospectively evaluated plasma concentrations of 23 amino acids and clinical courses of acute liver failure patients admitted to our center from 2004 to 2007.
[Results]The study comprised 8 patients. All patients met the criteria of fulminant hepatitis, and they comprised 5 men and 3 women with a median age of 38.0 (interquartile range 34.5-40.8) years. The value of total amino acids on admission was extremely high with a median of 10305.0 nmol/ml. In the treatment process, including treatment with plasma exchange or dialysis, total amino acid values decreased, and the values of BCAA showed normal or lower values.
[Conclusion]In patients with fulminant hepatitis, the values of most amino acids were high on admission and decreased by various treatments during hospitalization. Further study is required to clarify the timing and method of administration of amino acids.

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[in Japanese]

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