BETA - How are liver enzymes monitored and managed? What therapies have been known to affect liver values?

How are liver enzymes monitored and managed? Liver is an important organ in our body that performs a very important function of removing toxins from our body. Liver function can be affected by chemotherapy, which usually manifests itself in the lab work. What are some signs and symptoms of high liver enzymes? Oftentimes patients who have abnormal liver enzymes may feel a bit more fatigued, tired, nauseous and sometimes with very severe forms of liver injury, liver failure, they may also notice yellow discoloration of their skin, their eyes and that's time when you need to seek help and assistance from your physician team. Do any specific myeloma therapies affect the liver enzymes? Many different chemotherapies can affect liver enzymes and liver functioning. I think for patients who are newly diagnosed with myeloma, often signs, proteasome inhibitors like butazumab, curfewlizumab, therapies like that can actually affect your liver enzymes. How are abnormal liver enzymes managed? When we hold chemotherapy, these liver enzymes get better on their own. One important thing to remember would be that if you are on chemotherapy, that can affect liver enzymes. It's important to stay away from other medication, drugs, therapies, food items, beverages that can affect liver enzymes and cause them to be further degraded and elevated. What kinds of food and beverages can elevate liver enzymes? Alcohol consumption in excess can actually affect liver enzymes, especially when you're on chemotherapy. Similarly not all of the supplements, over-the-counter supplements, additives that we see that are available off the counter that have been validated by the, interrogated by the FDA, safe to be taken when the liver enzymes are elevated. And then I think importantly a lot of myeloma patients, they have pain in their bones and they take pain medicine. They can have Tylenol and excess of acetaminophen and Tylenol can also affect the liver enzyme. There may not be any foods that are in particular helpful for the liver directly, but there's always, there are foods that are helpful, that are helpful to avoid because they can damage the liver. And I think again when it comes to foods that can affect the liver, alcohol being top of the list that it can actually cause some damage. Fried food eventually do lead to accumulation of fat within the liver and a fatty liver is a common finding and it can eventually lead to damage to the liver, cirrhosis of the liver, decompensation where the liver is not able to perform its function. So if consumed over a long period of time, fatty food do contribute towards other medical conditions like hypertension, diabetes, high cholesterol. How will my doctor know if my liver enzymes are elevated? Usually liver enzymes when they are affected by chemotherapy or for that matter drugs other than chemotherapy or myeloma in itself will be elevated. There are three particular liver enzymes that we pay attention to, the AST, ALT and then bilirubin and alkaline phosphatase and they are actually routinely checked at least every single time we give chemotherapy to patients, especially intravenous and subcutaneous chemotherapy that we know can be affected by this chemotherapy and it's very easy to capture those abnormalities. It is a part of a blood test we call a comprehensive metabolic panel. So the blood test that we can do for myeloma includes CBCDs, basic metabolic panel and then comprehensive metabolic panel and the comprehensive metabolic panel will actually capture the liver enzymes, the AST, ALT, alkaline phosphatase and bilirubin. Is there a level that's considered too high? Liver enzymes at the end of the day are numbered and you know it's more important to look at a trend as well. Anytime your liver enzymes are elevated three to five times upper limit of the normal but it's AST, ALT, bilirubin, it's of concern and it should be monitored. And more importantly it's not just the elevation but also persistent elevation over a period of time I would say within a week time that would be concerning. Is there anything you want to talk about more? I think it's important to remember that liver is a very important organ for patients in myeloma because it actually helps detoxify a lot of the bad toxins that can be made by in the body when the patients have cancer and more importantly a lot of the chemotherapy drugs are also metabolized or cleared by the liver. So taking good care of your liver and its health is important. So I think that's an important message for myeloma patients.