FIGURE 2 Resolution of inadequate myelosuppression and skewed metabolism after allopurinol initiation. Panel A shows the average ANC over the course of maintenance therapy. Panel B shows the median percent time in range for patients before and after allopurinol treatment, as well as the median percent time in range for patients who did not receive allopurinol. Panel C shows the average 6MMP/6TGN metabolite ratio over the course of maintenance therapy. PanelD shows the median 6MMP/6TGN metabolite ratio for patients before and after allopurinol treatment, as well as the median metabolite ratio for patients who did not receive allopurinol. The green vertical line in panels A and C indicates the average start date of allopurinol during maintenance therapy for all patients who received it (mean = 229 days). The red and blue lines in indicate mean values for patients who were not treated with allopurinol and those who were treated with allopurinol, respectively, and are 95% confidence intervals. The data in panels B and D represent the medians of selected data with interquartile ranges. Abbreviations: 6MMP, 6-methylmercaptopurine, 6TGN, 6-thioguanine nucleotide, ANC, absolute neutrophil count. Figure created with BioRender.com.
FIGURE 3 Resolution of hepatotoxicity markers after allopurinol initiation. ALT (A ), AST (B ), Total Bilirubin (C ) and Direct Bilirubin (D ), kinetics are described graphically to demonstrate the effectiveness of allopurinol treatment for 6MP-induced hepatotoxicity. The green vertical line in each panel indicates the average start date of allopurinol after hepatotoxicity was documented. The harder dashed line indicates five times the upper limit of normal for each lab value, while the softer dashed lines indicate the normal range for each lab value. The blue lines show the average lab value for patients treated with allopurinol during the first twelve weeks after documented hepatotoxicity, and the shaded areas as 95% confidence intervals. Figure created with BioRender.com.