15 replies to this topic

[LivingWellWithCML]

Hi everyone,

So, it's been smooth sailing so far on Gleevec 400mg ... almost three months in.  However, I received a Jun 21 metabolic panel from the onc (in the mail and with no notes, ouch!), and two key liver numbers were up ... note that they were perfectly normal and steady until this point:

• AST (SGOT) = 137 IU/L (above normal)
  
• ALT (SGPT) = 46 IU/L (stil normal, but markedly higher than my last check)
  

I don't think these values on their own are much reason for concern at this point, but I wanted to see if others on Gleevec had to ensure some early elevation in liver numbers ... and perhaps a settling-in or decline as the body and liver got used to processing the toxicity of the medication.  I've almost eliminated every other variable - I weaned off blood pressure medication over the past couple of weeks (at the advice of my doctor - he felt that I could give it a shot), and I was taking a couple of other medications during late May and early-mid June and I'm almost done with everything.  I'm expecting to only be taking Gleevec by next week.  My red wine intake was definitely up during the July 4th holiday (LOL), but I'm prepared to stop consumption if needed - although I don't think it's the culprit because I was drinking a couple of small glasses of red wine per night throughout the early course of treatment with great liver numbers.

I wonder if the short-term medications I was taking in late May/early-mid June could've caused a temporary rise?  I suppose it's all speculation until I get my next panel...

Just curious if others endured an up-down or up-steady trend like this on Gleevec and survived to tell the tale without having to make a TKI switch.  I've been so happy with the absence of Gleevec side effects and am hoping/praying that this isn't a trend for the worse.

Other experiences?

Dan

[Trey]

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.medicinen...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.

[hannibellemo]

Dan,

Those numbers should be checked again fairly soon to make sure it is a glitch and there is no upward trend. On 7/29/09 my counts were AST 52/ALT 88, my local onc just said that they weren't very high and didn't order a recheck before my next appointment.

On 8/18/09 I went to Mayo for my usual FISH and examination and I mentioned the higher than normal enzyme levels. I was sent back down for more blood work and those numbers came back AST 531/ ALT 1112. That got their attention! I was immediately taken off Gleevec and Prilosec (it is also hard on the liver) had a CT that day that showed everything looked normal. Over the next ten days my counts rose to AST 752 / ALT 1344 before they fell to normal over the next 7 weeks. Here is a link to my thread on this http://community.lls...age/22413#22413

I started Sprycel in October and have had no liver glitches since. Dr. L was surprised that it happened after 8 months on G; in his experience liver issues show up earlier.

Don't want to scare you I just wanted to make sure you understand that this may be nothing, but needs to be watched.

Good luck!

Pat

[LivingWellWithCML]

Thanks Pat & Trey - this is very helpful feedback, and I appreciate it.

My understanding is that Gleevec-specific liver toxicity is pretty rare, yes?

[hannibellemo]

Yes, but it wasn't rare enough that I didn't experience it - don't let that thought keep you from having another metabolic panel within a week or two. Someone gave me a very sobering thought after this was all over, they said that they didn't think people with CML qualify for the liver transplant program.

I forgot to mention that my FISH came back at 4%, that was very disheartening, to know that it was working but that all the docs, including some from Novartis, felt my liver would be unable to tolerate G at any level.

But, I reached MMR on Sprycel within 8 months and (knock wood) in August it will have been maintained for a year.

Good luck!

Pat

[LivingWellWithCML]

I'm on it for sure, Pat -- already got my appointment set up in a couple of days for an updated panel.

Thanks for your help, and congrats on your MMR!

Dan

[jjg]

I get a metabolic panel with every CBC as standard. My ALT and AST bounce around, from where Pat's were as they were getting warmed up to go ballistic and then back to normal the next month. It seems to be something you want to keep a lazy eye on but not sweat until you see consistent elevation. I was stressed about the elevated numbers when I started treatment, then "destressed" when they went down. Then my hem gave me a copy of all my tests from the start of the year and I noticed they were elevated (but both < 100) BEFORE starting gleevec. Either I stressed for nothing or now I should be even more stressed. Heck these liver function tests are enough to drive a person to drink!

[hannibellemo]

jjg, that's the absolute truth!

Pat

[LivingWellWithCML]

Pat's experience definitely has me stressed, because I have been responding very well to Gleevec thus far (early) and would hate to make a switch because of liver issues.  It looks like elevated AST/ALT levels can be tied to many things too ... including strenuous exercise (which I'm doing religiously with daily distance running, swimming and weights 3x/week, etc.), as well as the antibiotic that I was taking in late-May through mid-June.  Or perhaps my typical 2 medium glasses/evening of red wine which I am halting for now in light of these numbers.  I all but eliminated liquor completely when I was diagnosed with CML in March, so I'd really be surprised if this increase is associated with alcohol consumption.

Out of curiosity, do either of you take other medications, or is your TKI the only one?  No need to share specifics ... just wondering.

BTW, my CML specialist looked at the numbers and he wasn't concerned.  His nurse told me over the phone yesterday, "This is normal with Gleevec, so we can check it again in 2 weeks".  An additional two weeks, however, is a full month since this last check, so I decided to set one up with my local onc for this week - just to be safe.

You all are right though ... watching these numbers really can drive someone crazy!  However, the red wine bottle shall remain unopened for now.

Dan

[CallMeLucky]

Just speculation of course, but if the numbers come back down (as they most likely will) then I would suspect the antibiotic to be the main culprit.

[sdl722]

Dan

I'm dealing with similar issues on Tasigna.  My last labs on 6/20 showed elevated bilirubin (1.6 versus high of 1.0) and ALT (85 versus high range of 56).  The physicians assistant and research nurse didn't seem too concerned.  However, like you my next appointment is not until July 28th, which would be over 5 weeks in between.  My dad's cousin is an oncologist and he'll occasionally look at my lab results.  He didn't seem all too concerned but was able to convince my local oncologist to order some more labs in between, so I am going back tomorrow morning just to check.  Basically having another data point doesn't hurt.  I know I've got some decent wiggle room in the lvier numbers before they have to hold dosage, but it would be nice to not have to worry about the side effects! I've gotten so used to getting pricked in the arm, so what's the deal about one more quick jab?

I have to take Tasigna twice a day and in the beginning I was taking my morning dosage after my blood was drawn (meaning it was over 14 hours since my last dosage around dinner time the night before).  But I've since started taking the morning dose before getting up (between 4am-6am), so it was only a few hours later that I had my labs.  Probably doesn't mean anything, but I am a finance guy so my mind is always trying to analyze these numbers in dozens of different ways.

Anyway, good luck with your next labs!

Stephen

[Trey]

Note also that AST is not very specific for the liver.  It is more often a measure of muscle-type injury.  ALT is more specific for the liver, but is not always conclusive of itself.  If a Comprehensive Panel Test shows the ALT and AST are very high, the doc should then do an actual Liver Panel Test which includes other factors such as alkaline phosphatase, lactate dehydrogenase, total protein, bilirubin, etc.

http://labtestsonlin...es/ast/tab/test

http://labtestsonlin...-panel/tab/test

[hannibellemo]

Dan,

They did all the additional blood tests that Trey was talking about, and more, on me. Fortunately, I didn't seem to be experiencing any liver damage so I biopsy was delayed to see how my counts came down.

I do not take any other medications other than vitamins, although I was taking Prilosec at the time and was taken off of that, too, because it has its own liver issues.

Pat

[LivingWellWithCML]

Hey everyone,

Thanks again for all of the feedback on this thread.  I got my CMP back today and AST/ALT numbers are right back into the normal range (~ 16).  Amazing!  So, why the spike?

The only explanation I have after researching and talking to some trusted medical folks is the introduction of a rigorous upper-body weight training routine within a week of the 6/21 CMP.  There are studies that correlate newly-introduced weight training with a temporary spike in both enzymes (especially AST, which is what mine showed).  So odds are that my liver is relatively healthy and functioning just fine - for now.

Better safe than sorry.  Sounds like a healthy glass of red wine tonight is in order, LOL ............

Dan

[hannibellemo]

That is very good news, Dan. Glad to hear it!

Pat