Non-invasive assessment of hepatic fibrosis in pediatric survivors of acute lymphoblastic leukemia: a cross-sectional study

Abstract Survival rates for pediatric acute lymphoblastic leukemia (ALL) have markedly improved; however, survivors remain at risk of long-term hepatic complications, including progressive fibrosis related to chemotherapy and prior viral infections. The objective of this study is to evaluate hepatic fibrosis in pediatric ALL survivors using a sequential non-invasive algorithm combining transient elastography (TE) and enhanced liver fibrosis (ELF) score. This comparative cross-sectional study included 159 pediatric ALL survivors who had completed therapy at least 2 years earlier and 99 age- and sex-matched healthy controls from two Egyptian oncology centers. Liver fibrosis was assessed using TE and serum biomarkers for calculation of the ELF score. The mean age at diagnosis was 6.9 ± 2.7 years, and at assessment, 11.1 ± 2.7 years. Hepatitis C virus (HCV) prevalence declined significantly from 75% during treatment to 5% at enrollment following antiviral therapy ( p  < 0.001). Fibrosis was detected in 75% of survivors by TE, predominantly moderate (F2) fibrosis. Combined TE/ELF assessment identified advanced fibrosis (≥ F3) in 6% of patients, while most survivors had mild-to-moderate fibrosis. Mean ELF score was significantly higher in survivors than controls (9.3 ± 1.2 vs. 4.5 ± 1.03, p  < 0.0001). Agreement between TE and ELF was fair (Cohen’s κ  = 0.34–0.39). HCV-positive survivors had significantly higher ELF scores than HCV-negative peers. Conclusion : Persistent hepatic fibrosis in pediatric ALL survivors was observed predominantly among patients with current or previous HCV exposure. A combined TE/ELF approach represents an effective non-invasive strategy for early detection and monitoring. What is Known • Hepatic complications are expected among ALL survivors due to significant exposure to medications and viral infections . What is New • Using sequential non-invasive algorithm combining transient elastography (TE) and enhanced liver fibrosis(ELF) revealed variable stages of hepatic fibrosis among 75% of ALL survivors particularly current or previous HCV positive patients. Moderate fibrosis was the most prevalent stage. HCV was successfully eradicated after treatment with DAAs medications in almost all treated pediatric patients.