Allopurinol use during maintenance therapy for acute lymphoblastic leukemia avoids mercaptopurine-related hepatotoxicity

Nicole M. Giamanco; Bethany S. Cunningham; Laura S. Klein; Dina S. Parekh; Anne B. Warwick; Kenneth Lieuw

doi:10.1097/MPH.0000000000000499

Allopurinol use during maintenance therapy for acute lymphoblastic leukemia avoids mercaptopurine-related hepatotoxicity

Nicole M. Giamanco, Bethany S. Cunningham, Laura S. Klein, Dina S. Parekh, Anne B. Warwick, Kenneth Lieuw

Department of Pediatrics

Research output: Contribution to journal › Article › peer-review

21 Scopus citations

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.

Original language	English (US)
Pages (from-to)	147-151
Number of pages	5
Journal	Journal of pediatric hematology/oncology
Volume	38
Issue number	2
DOIs	https://doi.org/10.1097/MPH.0000000000000499
State	Published - Jan 1 2016

All Science Journal Classification (ASJC) codes

Pediatrics, Perinatology, and Child Health
Hematology
Oncology

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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.",

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T1 - Allopurinol use during maintenance therapy for acute lymphoblastic leukemia avoids mercaptopurine-related hepatotoxicity

AU - Giamanco, Nicole M.

AU - Cunningham, Bethany S.

AU - Klein, Laura S.

AU - Parekh, Dina S.

AU - Warwick, Anne B.

AU - Lieuw, Kenneth

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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.

AB - 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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Allopurinol use during maintenance therapy for acute lymphoblastic leukemia avoids mercaptopurine-related hepatotoxicity

Abstract

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