L-carnitine and Vitamin B Complex for PEG-L-asparaginase-Induced Hepatotoxicity

Asparaginase is a part of combination chemotherapy for acute lymphoblastic leukemia. We present a 58-year-old woman with refractory acute lymphoblastic leukemia who developed asparaginase-induced hepatotoxicity after receiving intravenous PEG-L-asparaginase-based chemotherapy. The patient presented with hyperbilirubinemia and transaminitis. The patient was diagnosed with drug-induced liver injury due to PEG-L-asparaginase after a thorough evaluation for all other causes and received treatment with L-carnitine and vitamin B complex with normalization of liver numbers. Hepatic dysfunction was attributed to depletion of L-asparagine and glutamine, which impairs mitochondrial β-oxidation and induces steatosis. We reiterate the role of L-carnitine and vitamin B complex for the treatment of asparaginase-induced hepatotoxicity.