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After treatment and remission

Liver

The liver is the main organ that processes medicines, so it is often under strain during leukaemia treatment. This topic explains which liver effects can remain after treatment and how to protect it.

Last updated: ~2 min read
A warmly glowing clear liver with vessels of light inside.
Figure 1.The liver processes medicines.

01Short answer

During leukaemia treatment liver tests often change and usually return to normal after treatment ends. Long-term problems can be caused by: iron build-up after many blood transfusions (iron overload), some medicines (for example methotrexate, 6-mercaptopurine), liver GVHD after transplant, hepatitis B or C (mostly in people transfused many years ago), and fatty liver linked to steroids, excess weight and metabolic changes. The COG recommends liver tests (ALT, AST, bilirubin), ferritin and, when relevant, hepatitis screening for these people. The liver can regenerate; protecting it means limiting alcohol, a healthy weight, the hepatitis B vaccine and agreeing medicines with your doctor.

02Simple explanation

Liver tests often return to normal after treatment.

Risks: iron overload, medicines, GVHD, hepatitis.

Checks: ALT, AST, bilirubin, ferritin.

The liver can regenerate.

Limit alcohol and supplements.

03Scientific explanation

Iron overload: each red cell transfusion brings about 200–250 mg of iron; after many transfusions ferritin rises and iron collects in the liver (MedlinePlus).

Medicines: the COG recommends liver tests after methotrexate, mercaptopurine and thioguanine; thioguanine rarely affects the liver’s blood vessels.

Hepatitis: people transfused before 1992 (later in some countries) are advised to have hepatitis C screening (COG).

Fatty liver: steroids, excess weight and insulin resistance raise the risk of metabolic fatty liver disease (NIDDK).

04What happens in the body?

What does the liver do?

It processes medicines and toxins, makes proteins and clotting factors, stores energy and produces bile.

Iron overload

After many transfusions extra iron collects in the liver and other organs. A ferritin test shows this. When needed, your doctor prescribes treatment (venesection or chelation).

Rust-gold particles gathering in tissue.
Figure 2.Iron can build up after transfusions.

Hepatitis

Hepatitis B and C can silently damage the liver over years. Screening and the hepatitis B vaccine matter; modern treatment can cure hepatitis C.

Liver recovery

Liver cells can renew. Once the cause is removed, tests often return to normal.

A clear honeycomb with new cells brightening at the edges.
Figure 3.Liver cells can renew.

How to protect your liver

Limit alcohol, keep a healthy weight, stay active, agree herbal products and supplements with your doctor and have the hepatitis B vaccine.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Protecting the liver

Steps of liver follow-up.

Tests — ALT, AST, bilirubin.1TestsALT, AST, bilirubin.
Iron — Ferritin is checked.2IronFerritin is checked.
Hepatitis — Screening and vaccine.3HepatitisScreening and vaccine.
Protection — Limit alcohol.4ProtectionLimit alcohol.
LiverFunction is monitored.
ProtectionFrom hepatitis and toxins.
RecoveryThe liver renews.

06Liver risk and checks (simplified)

FactorPossible effectCheck
Many transfusionsIron overloadFerritin
Methotrexate, mercaptopurineChanged liver testsALT, AST, bilirubin
Allogeneic transplantLiver GVHDLiver tests
Transfusions long agoHepatitis B, CHepatitis tests
Steroids, excess weightFatty liverTests, ultrasound

* Your doctor sets the testing schedule.

07Key terms

ALT, AST
Liver cell enzymes.
Bilirubin
A bile pigment.
Ferritin
A protein that reflects iron stores.
Iron overload
Extra iron collecting in organs.
Chelation
Treatment that removes extra iron.
Hepatitis
Inflammation of the liver.

08Key points

  • Tests often return to normal.
  • Get checked for iron overload.
  • Have hepatitis screening.
  • Limit alcohol.
  • Agree supplements with your doctor.
  • The liver recovers.

09Frequently asked questions

My ferritin is high. What does that mean?

It may be iron overload after transfusions or inflammation; your doctor looks for the cause.

Can I drink alcohol?

Even with normal tests, keeping alcohol to a minimum is advised; discuss it with your doctor.

Do I need the hepatitis B vaccine?

Often yes, especially after a transplant; your doctor sets the schedule.

Are liver problems reversible?

Often yes, once the cause is removed.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. My ferritin is high. What does that mean?

  2. Can I drink alcohol?

  3. Do I need the hepatitis B vaccine?

  4. Are liver problems reversible?

  5. Does this information replace medical advice?

My questions

12Sources

  1. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  2. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  3. MedlinePlus (U.S. National Library of Medicine). Liver Function Tests
  4. MedlinePlus (U.S. National Library of Medicine). Ferritin Blood Test
  5. MedlinePlus (U.S. National Library of Medicine). Hepatitis
  6. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD)
  7. National Cancer Institute (NCI). Follow-Up Medical Care
  8. National Cancer Institute (NCI). Cancer Survivorship
  9. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  10. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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