Chemotherapy

Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Health Professional Version, National Cancer Institute.

Source updated: April 14, 2025 · Captured 2026-09-09.

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Context: Late Effects of the Digestive System / Hepatobiliary / Treatment-related risk factors for hepatobiliary late effects

Chemotherapeutic agents with established hepatotoxic potential include antimetabolite agents like 6-mercaptopurine, 6-thioguanine, methotrexate, and rarely, dactinomycin.

Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) and cholestatic disease have been observed after thiopurine administration, especially 6-thioguanine.[60]

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Progressive fibrosis and portal hypertension have been reported in a subset of children who developed VOD/SOS after treatment with 6-thioguanine.[60]

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Acute, dose-related, reversible VOD/SOS has been observed in children treated with dactinomycin for pediatric solid tumors.[61,62]

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In the transplant setting, VOD/SOS has also been observed after conditioning regimens that have included cyclophosphamide/TBI, busulfan/cyclophosphamide, and carmustine/cyclophosphamide/etoposide.[63] High-dose cyclophosphamide, common to all of these regimens, is speculated to be a potential causative factor.

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Preserved source evidence · Not medical advice