6-巯基嘌呤是儿童 ALL 维持治疗的基石。对 6MP 的响应通常由 ANC 决定。接受 6MP 时的治疗 ANC 范围在 500 至 1500/μL 之间。除了所需的骨髓抑制作用外，6MP 还与多种药物不良反应相关。增加 6MP 剂量可达到治疗性 ANC 值；然而，患者在获得骨髓抑制治疗之前可能会经历不良反应，通常被认为是“代谢失调”。别嘌呤醇可能会纠正倾斜的 6MP 代谢。对维持治疗期间抽取的 6MMP 和 6TGN 代谢物的 ALL 儿科患者进行别嘌呤醇的使用分析。主要结果评估了别嘌呤醇开始之前和之后在 ANC 治疗范围内花费的时间百分比。此外，还分析了别嘌呤醇治疗前后6MMP：6TGN比值的差异、肝毒性发生率和复发率。纳入95例患者进行分析。三十二名 (34%) 患者接受了别嘌呤醇治疗。接受别嘌呤醇治疗的患者和未接受别嘌呤醇治疗的患者之间的基线人口统计数据没有显着差异。当比较别嘌呤醇开始前和后的 ANC 值时，观察到处于治疗范围内的时间百分比有统计学上显着的增加（27% vs. 43%；p = .03）。此外，当比较别嘌呤醇启动前后的代谢物比率时，观察到 6MMP:6TGN 代谢物比率值显着下降（86.7 vs. 3.6；p< .0001）。别嘌呤醇显着增加了治疗 ANC 范围内的时间百分比并且可以安全地用于显着降低 6MMP:6TGN 代谢物的比例，减轻 6MMP 的不良副作用，并优化与 6TGN 相关的抗白血病作用。© 2024 John Wiley

6-mercaptopurine is a cornerstone of maintenance therapy for pediatric ALL. Response to 6MP is typically determined by the ANC. Therapeutic ANC range while receiving 6MP is between 500 and 1500/μL. In addition to desired myelosuppression, 6MP is associated with multiple adverse drug effects. Increased doses of 6MP can lead to therapeutic ANC values; however, patients may experience adverse effects before obtaining therapeutic myelosuppression, often deemed "skewed metabolism." Allopurinol may potentially correct skewed 6MP metabolism.Pediatric patients with ALL with 6MMP and 6TGN metabolites drawn during maintenance therapy were analyzed for allopurinol use. The primary outcome evaluated the percentage of time spent in therapeutic ANC range before and after allopurinol initiation. In addition, the difference in 6MMP:6TGN ratios before and after allopurinol initiation, incidence of hepatotoxicity, and rates of relapse, were analyzed.Ninety-five patients were included for analysis. Thirty-two (34%) patients received allopurinol. There were no significant differences in baseline demographics between the patients who received allopurinol and those who did not. When comparing ANC values pre- and post-allopurinol initiation, a statistically significant increase in the percentage of time spent in therapeutic range was observed (27% vs. 43%; p = .03). In addition, when comparing metabolite ratios pre- and post-allopurinol initiation, a statistically significant decrease in 6MMP:6TGN metabolite ratio values was observed (86.7 vs. 3.6; p < .0001).Allopurinol significantly increased the percent time in therapeutic ANC range and can be safely utilized to significantly lower the ratio of 6MMP:6TGN metabolites, alleviating the undesirable side effects of 6MMP, and optimizing the anti-leukemic effects associated with 6TGN.© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.