Hepatotoxicity of Combination Chemotherapy for Acute Myelocytic Leukemia

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Abstract
To the editor: Recently, reports have appeared that describe hepatotoxicity in patients with acute leukemia after combination chemotherapy with antimetabolites and anthracycline antibiotics (1, 2). Over the past 9 months since Dr. J. Lawrence Naiman (St. Christopher's Hospital for Children, Philadelphia, Pennsylvania) first brought to our attention four cases of possible hepatotoxicity after daunorubicin therapy, we have received a total of 13 reports on leukemia patients with hepatotoxicity after administration of 6-thioguanine or cytarabine (cytosine arabinoside), or both, in combination with the anthracycline antibiotic daunorubicin (see Table 1). Most of the patients were in remission at the onset of hepatic

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