Allopurinol Use During Maintenance Therapy for Acute Lymphoblastic Leukemia Avoids Mercaptopurine-related Hepatotoxicity

Journal of Pediatric Hematology/oncology
Nicole M GiamancoKenneth Lieuw

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.

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Citations

Jan 8, 2020·The Journal of Pharmacy and Pharmacology·Wen-Hao XuWei-Ke Su
Jun 27, 2018·Journal of Experimental & Clinical Cancer Research : CR·Rodrigo Prieto-BermejoÁngel Hernández-Hernández
Mar 23, 2021·Journal of Pediatric Hematology/oncology·Ruchika Kamojjala, Bruce Bostrom
Apr 11, 2021·Journal of Biological Inorganic Chemistry : JBIC : a Publication of the Society of Biological Inorganic Chemistry·Ingrid O TravassosElisângela P de Silveira-Lacerda

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