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Very high AST and ALT on last test


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#1 gianfranko

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Posted 06 September 2014 - 11:19 AM

My wife's (who has been taking gleevec for 4 years now) last liver toxicity tests are showing really high AST and ALT levels:

 

09/03 - Blood Draw:

 

AST 417  (ref interval 10-30)

ALT 253  (ref interval 6-29)

Bilirubin 2.8 (ref interval 0.2-1.2)

 

Previous results had been normal.  For example the tests done in July show:

 

07/16 - Blood Draw:

 

AST 18  (ref interval 10-30)

ALT 11  (ref interval 6-29)

Bilirubin 0.4 (ref interval 0.2-1.2)

 

Anyone have any experience with this?  Should she still be taking gleevec or stop until levels normalize?

 

So far the doctor drew blood to check for hepatitis, and we are awaiting results.



#2 Trey

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Posted 06 September 2014 - 03:07 PM

Although it could possibly be the drugs, it is not likely that alone due to the sudden onset.  Suddenly high ALT/AST is more likely a virus or tissue injury, such as a muscle, the heart included.  Hepatitis would usually be even higher levels, so less likely.

 

Did she:

1) Have a virus before the test?

2) Have any muscle injuries, pulls, etc prior to the test?

3) Have any chest pain recently?

 

The test should be re-done and if much lower then just a transient issue which implies nothing in particular.  The results do NOT by themselves imply her liver is failing or damaged.



#3 gianfranko

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Posted 08 September 2014 - 09:27 AM

Although it could possibly be the drugs, it is not likely that alone due to the sudden onset.  Suddenly high ALT/AST is more likely a virus or tissue injury, such as a muscle, the heart included.  Hepatitis would usually be even higher levels, so less likely.

 

Did she:

1) Have a virus before the test?

2) Have any muscle injuries, pulls, etc prior to the test?

3) Have any chest pain recently?

 

The test should be re-done and if much lower then just a transient issue which implies nothing in particular.  The results do NOT by themselves imply her liver is failing or damaged.

Trey,

 

Thanks for the reply.  I know that she hurt her leg early August during a gym exercise.  I am unsure if it could be that.  It seems the doctor drew blood (last Friday) to repeat the liver enzymes and to check for hepatitis.  The doctor mentioned that she might need to switch drugs, but from what I read online it seems it is okay for her to just stop taking gleevec and resume taking it at a later time (1month? 2 months?).  Gleevec has been working fine so I am hesitant to have her switch drugs.  One question: is it safe for her to stay on gleevec with her AST/ALT so high?



#4 Trey

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Posted 08 September 2014 - 04:28 PM

I would want a re-test to find out if it was a very temporary spike.  If it remains high after a couple weeks a drug break would be reasonable.  But these levels are not inherently hazardous unless she actually has some specific liver disease, but if so the indicators would go even higher. 



#5 hannibellemo

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Posted 09 September 2014 - 06:46 AM

My experience with AST/ALT increase with Gleevec - I noticed a small increase (around 80) with a blood draw at my local cancer center. My next appointment at Mayo was 3 weeks later and at that point the AST had increased to around 500. My onc there ordered an ALT (that test is more liver specific) and it was also elevated to around 1100. He told me it was not viral or muscle related at that point, I definitely had hepatitus (refers to any inflamation of the liver). I was taken off Gleevec and Prilosec (also hard on liver) to allow my counts to return to normal. He also had an ultrasound done and other than a couple of cysts of no concern, my liver appeared normal and I felt fine. My AST/ALT rose for a week or so to around 700/1300 and then steadily dropped over a 7-9 week period. 

 

There was an Italian study done, very small sample, that indicated this might be an autoimmune response to Gleevec and short-term high level steroids allowed most participants to resume Gleevec. My docs weren't particularly interested in that mode of treatment and since Sprycel was available at that point a switch was made instead.

 

I was disappointed because I really liked Gleevec. 

 

Please let us know what happens and what you decide to do.

 

Good luck!

 

Pat


Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#6 gianfranko

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Posted 10 September 2014 - 08:52 AM

My experience with AST/ALT increase with Gleevec - I noticed a small increase (around 80) with a blood draw at my local cancer center. My next appointment at Mayo was 3 weeks later and at that point the AST had increased to around 500. My onc there ordered an ALT (that test is more liver specific) and it was also elevated to around 1100. He told me it was not viral or muscle related at that point, I definitely had hepatitus (refers to any inflamation of the liver). I was taken off Gleevec and Prilosec (also hard on liver) to allow my counts to return to normal. He also had an ultrasound done and other than a couple of cysts of no concern, my liver appeared normal and I felt fine. My AST/ALT rose for a week or so to around 700/1300 and then steadily dropped over a 7-9 week period. 

 

There was an Italian study done, very small sample, that indicated this might be an autoimmune response to Gleevec and short-term high level steroids allowed most participants to resume Gleevec. My docs weren't particularly interested in that mode of treatment and since Sprycel was available at that point a switch was made instead.

 

I was disappointed because I really liked Gleevec. 

 

Please let us know what happens and what you decide to do.

 

Good luck!

 

Pat

 

 

I would want a re-test to find out if it was a very temporary spike.  If it remains high after a couple weeks a drug break would be reasonable.  But these levels are not inherently hazardous unless she actually has some specific liver disease, but if so the indicators would go even higher. 

 

Trey and Pat,

 

Thanks for your responses.  I apologize for the late response.  I used to get email updates on forums threads I had created/posted, but it seems to not be working anymore.

 

The test results from last Friday came back and everything in the liver panel was normal!  Also, no hep A, B, or C detected.  That kind of leaves us wondering why the past test was so abnormally high...Lab error?  Or just an unexplained spike?  In any case, my wife and I are back to feeling at ease.

 

Again, thanks for all the information and help!

 

-Franco



#7 Trey

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Posted 10 September 2014 - 02:21 PM

These blood count issues happen all the time to everyone, with and without leukemia.  But only special people like us get to know that our counts go all over the map for no particular reason, and it means nothing in particular.  Which is why I emphasized a re-test before getting concerned.  Glad she is doing well.






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