Chemotherapy-Induced Unconjugated Hyperbilirubinemia Complicated by Other Trigger Factors in a Child with T-Cell Acute Lymphoblastic Leukaemia and UGT1A1 Mutation-Associated Gilbert Syndrome
Bibliographic record
Abstract
Gilbert syndrome (GS) is an inherited disorder characterised by unconjugated hyperbilirubinemia due to a deficiency in hepatic UDP-glucuronosyltransferase 1A1 (UGT1A1) enzyme activity, responsible for bilirubin glucuronidation. This results in decreased bilirubin conjugation and excretion, leading to elevated serum unconjugated bilirubin levels. In T-cell acute lymphoblastic leukaemia (T-ALL), treatment typically involves intensive chemotherapy regimens that include agents metabolised by the liver, requiring careful consideration of liver function and bilirubin metabolism in patients with concurrent GS. We present the case of a 15-year-old male who was diagnosed with T-ALL and treated with a chemotherapy regimen following the modified Dutch Child Oncology Group ALL-9 (High Risk) protocol. Concurrently, the patient was observed to have persistent unconjugated hyperbilirubinemia aggravated by infection and fasting despite normal to mildly deranged liver function, which was initially assumed to be attributed by 6-Mercaptopurine (6-MP). Further workup confirmed a diagnosis of GS based on clinical history, laboratory findings, and genetic testing. We recommend performing a genetic analysis of UGT1A1 in patients presenting with chemotherapy-induced hyperbilirubinemia with no signs of liver impairment. This aims to prevent unnecessary alterations in chemotherapy regimens that could potentially increase the risk of relapse.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".