Conclusions
- The incidence of aberrant metabolism of mercaptopurine in our study
was above 50% and is likely more prevalent in the ALL and LL
populations than previously reported
- Utilizing our proposed algorithm for introduction the of allopurinol
to mitigate mercaptopurine metabolite toxicity is both a safe and
effective intervention, but does require close interval monitoring
- Identification of a therapeutic 6-MMPN:6-TGN ratio may be helpful in
guiding decisions to start hybrid allopurinol-mercaptopurine therapy
as well as guide dose titration.