A Retrospective Review of Mercaptopurine Metabolism Reveals High Rate of Patients With Suboptimal Metabolites Successfully Corrected With Allopurinol. Issue 7 (October 2021)

• Record Type: Journal Article
• Authors: Vasta, Lauren M.; Zanetti, Richard C.; Parekh, Dina S.; Warwick, Anne B.; Lieuw, Kenneth
• Is Part Of: Journal of pediatric hematology/oncology. Volume 43:Issue 7(2021)
• Publication Date: 2021-10
• Subjects: acute lymphoblastic leukemia -- 6-mercaptopurine -- allopurinol -- pediatric -- young adult; Pediatric hematology -- Periodicals; Tumors in children -- Periodicals; 618.9215
• DOI: 10.1097/MPH.0000000000001939
• Languages: English
• ISSNs: 1077-4114

Abstract

Abstract : Skewed drug metabolism of 6-mercaptopurine (6-MP) can jeopardize antileukemic effects and result in toxicities during the treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma. Allopurinol can alter 6-MP metabolism to maximize therapeutic effects while reducing toxicities. Over 75% of our patients with acute lymphoblastic leukemia or lymphoblastic lymphoma experienced a 6-MP-related toxicity. Review of metabolite date a showed 6-methylmercaptopurine nucleotide levels were >10, 000 in 55% of the cohort, suggesting 6-MP shunting. Allopurinol was initiated in 12 of 23 shunters with resolution of toxicities. We propose an algorithm to incorporate allopurinol into chemotherapy regimens for patients with inappropriate 6-MP metabolism. Abstract : Supplemental Digital Content is available in the text.