Elevated serum transaminase activity at diagnosis is associated with rapidly progressing disease in children with acute lymphoblastic leukemia

The authors study whether quantitative measurement of serum glutamate pyruvate transaminase (SGPT) activity might serve as an indicator of liver involvement at diagnosis of acute lymphoblastic leukemia (ALL) and could be used as a parameter in predicting the prognosis of individual patients. The series consisted of 123 children with newly diagnosed untreated ALL. The mean follow-up time was 69 months (range, 22-140 months). The SGPT activity at diagnosis was significantly associated with the duration of event-free survival (P less than 0.0001). For the 13 patients with SGPT activity greater than 40 IU/l the 5-year event-free survival was only 9%. All 11 patients with the lowest SGPT activities (less than 8 IU/l) remain in primary remission (24 to 81 months). The relative risk of relapse or death for children with SGPT activities of less than 8 IU/l, 8-40 IU/l, and greater than 40 IU/l were 0.2 (95% confidence limits 0.09-0.45), 1, and 4.8 (2.2-10.7), respectively (P less than 0.001). The SGPT activity at diagnosis was not associated with clinically assessed liver enlargement. The authors speculate that high SGPT activities at diagnosis are associated with a rapidly progressing, fulminant form of ALL.