Allopurinol Use During Maintenance Therapy for Acute Lymphoblastic Leukemia Avoids Mercaptopurine-related Hepatotoxicity. Issue 2 (March 2016)

• Record Type: Journal Article
• Authors: Giamanco, Nicole M.; Cunningham, Bethany S.; Klein, Laura S.; Parekh, Dina S.; Warwick, Anne B.; Lieuw, Kenneth
• Is Part Of: Journal of pediatric hematology/oncology. Volume 38:Issue 2(2016)
• Publication Date: 2016-03
• Subjects: 6-mercaptopurine -- allopurinol -- hepatotoxicity -- pharmacogenetics -- acute lymphoblastic leukemia; Pediatric hematology -- Periodicals; Tumors in children -- Periodicals; 618.9215
• DOI: 10.1097/MPH.0000000000000499
• Languages: English
• ISSNs: 1077-4114

Abstract

Abstract : 6-Mercaptopurine (6-MP) is the mainstay of treatment for acute lymphoblastic leukemia and lymphoblastic lymphoma. It is metabolized into the pharmacologically active, 6-thioguanine nucleotide (6-TGN), and 6-methyl mercaptopurine nucleotides (6-MMPN), which is associated with hepatotoxicity that jeopardizes antileukemic therapy. Allopurinol alters the metabolism of 6-MP to increase 6-TGN levels and decreases 6-methyl mercaptopurine nucleotides levels. We report 2 cases in which combination therapy of allopurinol with 6-MP was used successfully to avoid hepatotoxicity while delivering adequate 6-TGN levels. We suggest that this combination therapy can be used safely to change the metabolite production in patients who develop excessive hepatotoxicity.