PMC6392151_01
Treatment regimen for patient in Case 1.. On the horizontal axis is the day of maintenance therapy from the start to completion. On the vertical axis are the red cell thiopurine metabolite values and drug doses. Interruption in drug doses is noted by a break in the line. For graph clarity, 6-methyl-mercaptopurine (6MMP) values were divided by 100 and 6-thioguanine nucleotide (6TGN) values by 10. After introduction of allopurinol, the 6MMP levels rapidly fell to undetectable levels with stable 6TGN. Following the initial introduction of allopurinol in patient 1 the mercaptopurine (6MP) and methotrexate (MTX) doses required interruption due to neutropenia which did not recur with a dose reduction of 6MP. As expected the myelosuppression was associated with a very elevated 6TGN level.
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Figure 1 contains details of oral chemotherapy doses and laboratory values.
PMC6392151_02
Treatment regimen for patient in Case 2.. On the horizontal axis is the day of maintenance therapy from the start to completion. On the vertical axis are the red cell thiopurine metabolite values and drug doses. For graph clarity, 6-methyl-mercaptopurine (6MMP) values were divided by 100 and 6-thioguanine nucleotide (6TGN) values by 10. After introduction of allopurinol, the 6MMP levels rapidly fell to undetectable levels with stable 6TGN. Of note the high glucose values during dexamethasone pulses resolved after introduction of metformin on day 255.
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Figure 2 contains details of oral chemotherapy doses and laboratory values.