13 replies to this topic

[Terrasage]

I am probably over-reacting, but am concerned never the less about a recent LFT which was slightly elevated.  I had another test done last week and will call tomorrow for the results.  If it remains elevated, how will it be addressed?  I have been on Gleevec 400 mg since 3/09.

I'm feeling mighty uneasy lately given this information and then I heard through the grapevine that some other people in my area with CML have not been doing well.  It's so easy to get psyched out.  Just 3 weeks ago I pretty much took the gleevec and forgot about having CML most of the time.

Thanks! 

[Trey]

To some degree it depends on which LFT enzymes are elevated, and for how long.  LFT tests can be skewed on a single test for a variety of reasons, so I would not get overly concerned yet, since these things can come and go based on a lot more than just CML drugs.  ALT and AST are the primary liver function indicators.  ALT is the best indicator, since it is only produced in the liver, so if it is high for a couple tests, then that is something that requires attention.  If AST is elevated, that can be from muscle injury or other issues besides the liver, but can also be from the liver.  I have had a couple tests where AST was high then the next test it was completely normal.  So by itself AST is not the best indicator since there are several possible causes outside the liver.  So get a copy of the lab report and see what "elevated LFT" actually means.

Generally, 400mg Gleevec is not that hard on the liver unless a person is taking other drugs.  I realize you already had a second test done, but if you are taking other drugs I would stop them -- ONLY if your doctor allows -- a few days before a next LFT test is done.  Also avoid alcohol prior to any next test, and watch for any muscle strains or injuries prior to an LFT test.

http://www.atdn.org/simple/liverfun.html

[Terrasage]

Trey-bien...you are trey-kind, as always!

Thanks again!

[MichelleBPT]

Are LFT a standard part of treatment for everyone?

[janekaye]

I have had three, I believe, since dx in September.  I've been led to believe that they're very important, given the fact that the drugs we take are metabolized by the liver.  Now that I'm on Sprycel, I've been watching those numbers, and in fact, picked up a copy of my latest numbers yesterday at my oncologist's, just to check the LFT numbers.  So far, so good................  I'm wondering if it's true that Sprycel is harder on the liver than Gleevec.  I'll have to do my reading that Trey so kindly sent.  I need to know more about my "new drug."

janekaye

[Terrasage]

Trey, I was looking through my test results since diagnosis, and it appears that I have had 2 LFT in which ALTs came back high--not two tests in a row, and the rest of the tests were normal.  Any thoughts on this?

Also, it appears that in the April, the PCR test did not detect the BCR-ABL, but in June, it was .22%.  Does this make sense?!  I don't think the same labs did the tests, and I will double-check on this with my doctor.

I'm trying to attach all of my blood test results from the last few months, I'm not sure it's going to work though...thanks again for your help.

[everonward]

Hi all

My doctors run an LFT every time my bloods are done - 6 weekly (approx).  I never hear what the numbers are but have an agreement that if they are off I will be told.

Marian in the UK

[Trey]

If the ALT goes from high to mid-range normal, it is likely a transient issue.  If ALT goes from high to high-range normal, then it may be a more persistent issue that requires attention.

[MichelleBPT]

Thanks everyone for the info on the LFT. I saw my oncologist last Thursday and he agreed, with my suggestion, to run a full metabolic panel. He didn't seem to think it was neccessary to do at first which is a little worrisome since it sounds pretty standard for CML. Are there any other tests I should ask about, beyond the CBC and BMB?   Also, my dosage of G was increased to 600 mg. My platelets were in the 900s, my onc told me it was "nothing to freak out about". Doesn't this seem unusually high? Are there things I should be worried about?

[Trey]

Please see my "CML Testing Explained" posting...

Regarding high platelets, the platelets are often the last item to stabilize.  It was that way for me.  While everything else was going down, they were rising.  Seems you have the same issue.  But your doc needs to monitor them.  You are young, but older folks with heart problems could have serious issues with high platelets (thick blood mixed with partially blocked arteries is not a good thing).

[MichelleBPT]

It's good to know someone else has had a similar situation. Since I just started taking 600 mg, the doctor wants to see me in 3 weeks to see if the platelets are responding. It does feel good to finally see some values that are within normal limits. Looks like it takes some tine for things to get "fine tuned".

[Trey]

I found some some good reading on the liver enzyme subject:

"Mild to moderate elevations of the liver enzymes are  commonplace. They are often unexpectedly encountered on  routine blood screening tests in otherwise healthy  individuals. The AST and ALT levels in such cases are  usually between twice the upper limits of normal and  several hundred units/liter."

http://www.medicinenet.com/liver_blood_tests/page3.htm

So this helps put the issue of elevated ALT or AST into perspective, that "mild to moderate elevations" are considered to be two or more times the upper limit of normal.  That might show that slight elevations may not be so much to be concerned about.  My Onc says these numbers can bounce around quite a bit based on other factors, especially AST.  But that does not mean they should be ignored if they are consistently above the normal range.

[Terrasage]

Thanks again Trey--that information gives me some comfort.  I don't think my LFT were anywhere near doubled the norm.

[ncook]

Thanks Trey for the link!  My moms ALT and AST are up to the 300's, in her case it could be due to the septis shock however that was a month ago and now they are treating her with more meds for infections.. These numbers went from normal to high since last week.. nicole