My Brother%E2%80%99s Case He Was Diagnosed In May 2018 By

Posted on Sat, 29 Aug 2020

Question:
My brother%E2%80%99s case
He was diagnosed in May 2018 by MM and Amyiliodosis , was subject to chemotherapy treatment for 4 months followed by bone marrow transplant in UK.
Since then he is undergoing maintenace chemotherapy treatment taking Darzalex and Ninlaro beside antivirus and anti bacteria: Zovirax and Trimidar since May 2019.
In last XXXXXXX his blood tests started showing unusual increase in liver enzymes APT (241) AST ( 69) and IGG(680) beside total bilirubin total at 1.68 .
His doctor stopped the Ninlaro for 5 weeks but still no improvement in liver enzymes.
Any clue

Follow up: Dr. Indranil Ghosh (0 minute later)

My brother%E2%80%99s case
He was diagnosed in May 2018 by MM and Amyiliodosis , was subject to chemotherapy treatment for 4 months followed by bone marrow transplant in UK.
Since then he is undergoing maintenace chemotherapy treatment taking Darzalex and Ninlaro beside antivirus and anti bacteria: Zovirax and Trimidar since May 2019.
In last XXXXXXX his blood tests started showing unusual increase in liver enzymes APT (241) AST ( 69) and IGG(680) beside total bilirubin total at 1.68 .
His doctor stopped the Ninlaro for 5 weeks but still no improvement in liver enzymes.
Any clue

Answered by Dr. Indranil Ghosh (13 hours later)

Brief Answer:
We need to rule out other causes

Detailed Answer:
Hi
Thanks for your query.

I understand your concerns.

Ninlaro can cause liver toxicity but it should improve on stopping the therapy. So we need to rule out other causes, like viral hepatitis and amyloid deposit in liver.

I recommend all viral markers like hepatitis b,c and CMV. Also an ultrasound of the liver. For the time being ursodexoycholic acid and vitamin E can be tried to bring down the liver enzymes.

Based upon the results of these, we can proceed further.

Hope this helps.
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Indranil Ghosh (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Indranil Ghosh (38 minutes later)

Thanks Dr. In fact CMV, Hepatitis b,c were done beside ultrasound of liver all were OK,
What can be the cause ?

Follow up: Dr. Indranil Ghosh (0 minute later)

Thanks Dr. In fact CMV, Hepatitis b,c were done beside ultrasound of liver all were OK,
What can be the cause ?

Answered by Dr. Indranil Ghosh (3 hours later)

Brief Answer:
Need to see report of ultrasound

Detailed Answer:
Ok, if possible, please upload the ultrasound report.

We should also do a fibroscan of the liver to rule out chronic liver disease (chemo/BMT induced/fatty liver related)

Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Indranil Ghosh (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Indranil Ghosh (9 hours later)

see US report attached

Follow up: Dr. Indranil Ghosh (0 minute later)

see US report attached

Follow up: Dr. Indranil Ghosh (2 minutes later)

Dr I forgot to say that he was also taking azithromycin

Follow up: Dr. Indranil Ghosh (0 minute later)

Dr I forgot to say that he was also taking azithromycin

Answered by Dr. Indranil Ghosh (2 hours later)

Brief Answer:
Usg doesn't reveal anything

Detailed Answer:
Hence I would recommend liver fibroscan and trying those medicines I mentioned.

You can discuss these with his doctor.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Indranil Ghosh (0 minute later)

Brief Answer:
Usg doesn't reveal anything

Detailed Answer:
Hence I would recommend liver fibroscan and trying those medicines I mentioned.

You can discuss these with his doctor.

Regards

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Prasad