GPT and Thrombocytopenia: The most frequently reported grade 3 or 4 adverse events include thrombocytopenia and elevated serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) [7,8]. The emtansine (DM1) component may cause direct endothelial injury by disrupting microtubule dynamics in endothelial cells, resulting in vascular dysfunction.