title: Allopurinol Use During Maintenance Therapy for Acute Lymphoblastic Leukemia Avoids Mercaptopurine-related Hepatotoxicity.
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.
authors.affiliation: *Department of Pediatrics, Walter Reed National Military Medical Center †Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Giamanco
authors.forename: Bethany S
authors.initials: BS
authors.lastname: Cunningham
authors.forename: Laura S
authors.initials: LS
authors.lastname: Klein
authors.forename: Dina S
authors.initials: DS
authors.lastname: Parekh
authors.forename: Anne B
authors.initials: AB
authors.lastname: Warwick
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lieuw
mesh_terms: D000293:Adolescent; D000493:Allopurinol / Q000008:administration & dosage*; D000963:Antimetabolites / Q000008:administration & dosage*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D002648:Child; D006801:Humans; D008099:Liver / Q000187:drug effects; D060046:Maintenance Chemotherapy / Q000379:methods; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000963:Antimetabolites; D000964:Antimetabolites, Antineoplastic; D000493:Allopurinol; D015122:Mercaptopurine