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.