Study on the occurrence characteristics and influencing factors of chemotherapy-related liver function injury in children with leukemia

Chemotherapy has markedly improved the prognosis of childhood leukemia, yet chemotherapy-induced liver injury (CILI) remains a significant complication. This study aimed to evaluate the incidence and risk factors of CILI in a single-center retrospective cohort of 240 children with leukemia diagnosed between January 2023 and December 2024 who received chemotherapy. Liver injury was graded using CTCAE v5.0, and clinical and treatment-related variables were analyzed by χ² test and logistic regression. Overall, 62 patients (25.8%) developed CILI, most commonly characterized by hepatocellular injury (51.6%). The median time to onset was 12 days, with recovery at 15 days. Univariate analysis suggested associations with baseline liver dysfunction and infectious events, and multivariable regression confirmed both baseline hepatic abnormalities (OR = 2.73, 95% CI: 1.25-5.97, P = .012) and infections (OR = 2.18, 95% CI: 1.09-4.35, P = .028) as independent risk factors. CILI is common during chemotherapy for childhood leukemia, with baseline liver impairment and infection significantly increasing risk. Strengthening pretreatment evaluation, dynamic monitoring, and infection control, along with incorporating pharmacogenomics into risk prediction models, may improve individualized management and enhance treatment safety.