PMID- 30828444
OWN - NLM
STAT- MEDLINE
DCOM- 20200615
LR  - 20200615
IS  - 2046-1402 (Electronic)
IS  - 2046-1402 (Linking)
VI  - 8
DP  - 2019
TI  - Allopurinol reverses mercaptopurine-induced hypoglycemia in patients with acute 
      lymphoblastic leukemia.
PG  - 176
LID - 10.12688/f1000research.17760.2 [doi]
LID - 176
AB  - Fasting hypoglycemia is a known complication of mercaptopurine (6MP) maintenance 
      therapy for acute lymphoblastic leukemia (ALL). It is associated with high levels 
      of the methylated metabolite 6-methyl-mercaptopurine (6MMP). Symptoms of 
      hypoglycemia include morning tremulousness, nausea and vomiting. We have 
      previously shown that switching 6MP dosing from evening to morning resolved 
      hypoglycemia by reducing 6MMP; however, the reduction of 6MMP was only transient, 
      potentially resulting in return of hypoglycemia. In children and adults with 
      Crohn's disease, co-prescribing allopurinol with 6MP blocks the activity of 
      thiopurine methytransferase (TPMT), reducing 6MMP and improving its tolerance. As 
      a consequence of inhibiting TPMT, 6MP is shunted toward the production of 
      6-thioguanine nucleotide (6TGN), which will result in pancytopenia if the dose of 
      6MP is not reduced. We demonstrate that allopurinol with a reduced dose of 6MP in 
      two patients with ALL and 6MMP-associated hypoglycemia resulted in a complete and 
      sustained suppression of 6MMP and rapid reversal of hypoglycemia and its 
      symptoms.
CI  - Copyright: (c) 2019 Zhang M and Bostrom B.
FAU - Zhang, Melissa
AU  - Zhang M
AD  - University of California, Berkeley, Berkeley, CA, 94720, USA.
FAU - Bostrom, Bruce
AU  - Bostrom B
AUID- ORCID: 0000-0001-7974-1271
AD  - Department of Pediatric Oncology, Children's Hospitals and Clinics of Minnesota, 
      Minneapolis, MN, 55404, USA.
LA  - eng
SI  - figshare/10.6084/m9.figshare.7666409
PT  - Case Reports
PT  - Journal Article
DEP - 20190211
PL  - England
TA  - F1000Res
JT  - F1000Research
JID - 101594320
RN  - 0 (Antimetabolites, Antineoplastic)
RN  - 0 (Blood Glucose)
RN  - 0 (Enzyme Inhibitors)
RN  - 63CZ7GJN5I (Allopurinol)
RN  - E7WED276I5 (Mercaptopurine)
SB  - IM
MH  - Allopurinol/therapeutic use
MH  - *Antimetabolites, Antineoplastic/adverse effects/therapeutic use
MH  - Blood Glucose
MH  - Blood Glucose Self-Monitoring
MH  - Child
MH  - Child, Preschool
MH  - *Enzyme Inhibitors/therapeutic use
MH  - Female
MH  - Humans
MH  - *Hypoglycemia/chemically induced/drug therapy
MH  - *Mercaptopurine/adverse effects/therapeutic use
MH  - *Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
PMC - PMC6392151
OTO - NOTNLM
OT  - allopurinol
OT  - hypoglycemia
OT  - mercaptopurine
OT  - morning nausea
OT  - thiopurine methyltransferase
COIS- No competing interests were disclosed.
EDAT- 2019/12/11 06:00
MHDA- 2020/06/17 06:00
PMCR- 2019/11/21
CRDT- 2019/12/11 06:00
PHST- 2019/11/12 00:00 [accepted]
PHST- 2019/12/11 06:00 [entrez]
PHST- 2019/12/11 06:00 [pubmed]
PHST- 2020/06/17 06:00 [medline]
PHST- 2019/11/21 00:00 [pmc-release]
AID - 10.12688/f1000research.17760.2 [doi]
PST - epublish
SO  - F1000Res. 2019 Feb 11;8:176. doi: 10.12688/f1000research.17760.2. eCollection 
      2019.