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: Nicole M Giamanco, Bethany S Cunningham, Laura S Klein, Dina S Parekh, Anne B Warwick, Kenneth Lieuw
• Journal: Journal of pediatric hematology/oncology (J Pediatr Hematol Oncol) Vol. 38 Issue 2 Pg. 147-51 (Mar 2016) ISSN: 1536-3678 [Electronic] United States
• PMID: 26808368 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antimetabolites
• Antimetabolites, Antineoplastic
• Allopurinol
• Mercaptopurine

Topics

• Adolescent
• Allopurinol (administration & dosage)
• Antimetabolites (administration & dosage)
• Antimetabolites, Antineoplastic (administration & dosage, adverse effects, metabolism)
• Child
• Humans
• Liver (drug effects)
• Maintenance Chemotherapy (methods)
• Male
• Mercaptopurine (administration & dosage, adverse effects, metabolism)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy)