PMID- 24415675
OWN - NLM
STAT- MEDLINE
DCOM- 20140604
LR  - 20171116
IS  - 1545-5017 (Electronic)
IS  - 1545-5009 (Linking)
VI  - 61
IP  - 6
DP  - 2014 Jun
TI  - The association between fasting hypoglycemia and methylated mercaptopurine 
      metabolites in children with acute lymphoblastic leukemia.
PG  - 1003-6
LID - 10.1002/pbc.24928 [doi]
AB  - BACKGROUND: Symptomatic fasting hypoglycemia has been reported as an unusual side 
      effect in patients with acute lymphoblastic leukemia (ALL) on maintenance 
      therapy. We evaluated the relation of the red cell 6-mercaptopurine (6-MP) 
      metabolite 6-methyl-mercaptopurine (6MMP) with hypoglycemia. PROCEDURE: We 
      retrospectively reviewed charts of three patients with ALL and symptomatic 
      hypoglycemia while fasting who were noted to have high levels of 6MMP. All 
      patients had an empiric trial of switching from evening to morning 6-MP 
      administration, and two patients were subsequently switched to twice daily 
      dosing. Patients also received complex carbohydrates at bedtime. RESULTS: 
      Switching 6-MP from evening to morning administration reduced 6MMP levels yet 
      preserved adequate levels of the active metabolite red cell 6-thioguanine 
      nucleotide (6TGN). All patients had decreased hypoglycemic events when changed 
      from evening to morning dosing. Two patients showed a rebound in 6MMP levels with 
      return of hypoglycemic symptoms. Both were then switched to twice daily 6-MP 
      dosing with one having a decrease in 6MMP and hypoglycemic symptoms. CONCLUSIONS: 
      High levels of 6MMP are associated with symptomatic hypoglycemia which may be 
      mitigated by switching to morning or twice daily 6-MP dose administration.
CI  - (c) 2014 Wiley Periodicals, Inc.
FAU - Melachuri, Samyuktha
AU  - Melachuri S
AD  - Pediatric Hematology/Oncology, Children's Hospitals and Clinics of Minnesota, 
      Minneapolis, Minnesota.
FAU - Gandrud, Laura
AU  - Gandrud L
FAU - Bostrom, Bruce
AU  - Bostrom B
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20140110
PL  - United States
TA  - Pediatr Blood Cancer
JT  - Pediatric blood & cancer
JID - 101186624
RN  - 0 (Antimetabolites, Antineoplastic)
RN  - 0 (Blood Glucose)
RN  - 0 (Dietary Carbohydrates)
RN  - 0 (Guanine Nucleotides)
RN  - 0 (Liver Glycogen)
RN  - 0 (Prodrugs)
RN  - 0 (Thionucleotides)
RN  - 15867-02-4 (6-thioguanylic acid)
RN  - 6V404DV25O (6-methylthiopurine)
RN  - 7S5I7G3JQL (Dexamethasone)
RN  - E7WED276I5 (Mercaptopurine)
RN  - EC 2.1.1.- (Methyltransferases)
RN  - EC 2.1.1.67 (thiopurine methyltransferase)
RN  - EC 2.4.2.8 (Hypoxanthine Phosphoribosyltransferase)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Antimetabolites, Antineoplastic/administration & dosage/*adverse 
      effects/pharmacokinetics
MH  - Antineoplastic Combined Chemotherapy Protocols/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Biotransformation
MH  - Blood Glucose/analysis
MH  - Child
MH  - Child, Preschool
MH  - Dexamethasone/administration & dosage/adverse effects
MH  - Dietary Carbohydrates/administration & dosage
MH  - Drug Administration Schedule
MH  - Fasting/*blood
MH  - Female
MH  - Guanine Nucleotides/*blood
MH  - Humans
MH  - Hyperglycemia/chemically induced
MH  - Hypoglycemia/*chemically induced
MH  - Hypoxanthine Phosphoribosyltransferase/genetics/metabolism
MH  - Infant
MH  - Liver Glycogen/metabolism
MH  - Maintenance Chemotherapy
MH  - Male
MH  - Mercaptopurine/administration & dosage/*adverse effects/*analogs & 
      derivatives/blood/pharmacokinetics
MH  - Methotrexate/administration & dosage
MH  - Methylation
MH  - Methyltransferases/genetics/metabolism
MH  - Polymorphism, Genetic
MH  - Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/blood/*drug therapy/enzymology
MH  - Prodrugs/administration & dosage/adverse effects/pharmacokinetics
MH  - Retrospective Studies
MH  - Thionucleotides/*blood
OTO - NOTNLM
OT  - 6-mercaptopurine
OT  - 6MMP
OT  - ALL
OT  - ALT
OT  - hypoglycemia
OT  - thiopurine metabolites
EDAT- 2014/01/15 06:00
MHDA- 2014/06/05 06:00
CRDT- 2014/01/14 06:00
PHST- 2013/06/05 00:00 [received]
PHST- 2013/12/12 00:00 [accepted]
PHST- 2014/01/14 06:00 [entrez]
PHST- 2014/01/15 06:00 [pubmed]
PHST- 2014/06/05 06:00 [medline]
AID - 10.1002/pbc.24928 [doi]
PST - ppublish
SO  - Pediatr Blood Cancer. 2014 Jun;61(6):1003-6. doi: 10.1002/pbc.24928. Epub 2014 
      Jan 10.