mercaptopurine / Generic mfg. - LARVOL DELTA

Early Toxicity in Childhood Acute Lymphoblastic Leukemia: A Comparison of NOPHO ALL2008 and ALLTogether Protocols in Sweden. (PubMed, Pediatr Blood Cancer) - P, P3, P3/4 | "The early introduction of asparaginase likely contributed to increased weight gain, hyperglycemia, and osteonecrosis. While overall toxicity burden remained similar between protocols, the shift in toxicity profile may explain the perception of increased early toxicity during treatment with the ALLTogether protocol."

Journal • Acute Lymphocytic Leukemia • Diabetes • Hematological Malignancies • Hepatology • Leukemia • Liver Failure • Oncology • Pediatrics

T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA RELAPSE AFTER CAR-T THERAPY (EBMT 2026) - "Background: Tisagenlecleucel (formerly CTL019), an anti-CD19 chimericantigen receptor (CAR) T-cell therapy, is an establishedtreatment for pediatric patients with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL)...Prior to CAR-T therapy, the patient received multiple chemotherapy regimens, including RE-ALL (with a measurable residual disease [MRD] of 38.36% at the end of induction phase 2), cytarabine and etoposide, hyper-CVAD, and blinatumomab (post-treatment bone marrow MRD of 59.7% blasts)...The patient underwent lymphodepletion with fludarabine (120 mg/m²) and cyclophosphamide (1000 mg/m²), followed by the first CAR-T cell infusion...The topotecan regimen was repeated, and a second CAR-T cell infusion was administered...A new treatment regimen with vincristine and PEG-asparaginase was initiated, followed by three doses of inotuzumab...Currently, six months after relapse, the patient remains on low-dose methotrexate and mercaptopurine, with..."

Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Bone Marrow Transplantation • Hematological Malignancies • Inherited Retinal Dystrophy • Leukemia • Ophthalmology • T Acute Lymphoblastic Leukemia • T-cell Acute Lymphoblastic Lymphoma

Low Intensity Mini-Hypercvd (mHCVD), Inotuzumab Ozogamicin (Ino) with/without Blinatumomab (Blina) in Older Patients with Newly Diagnosed Philadelphia Negative B-Cell Acute Lymphoblastic Leukemia (B-ALL): 10 Years Update (ASH 2024) - "The chemotherapy backbone was mHCVD (mHCVD : cyclophosphamide 150mg/m2 q12h [day] D1-3, dexamethasone 20mg/day D1-4, 11-14, and vincristine 2 mg D1, 8; alternating with methotrexate (MTX) 250mg/m2 D1 & cytarabine 500mg/m2 q12h D2, 3) for up to 8 cycles (C). 12 doses of intrathecal IT MTX /cytarabine were given for CNS prophylaxis; pts with CNS disease had IT hydrocortisone, MTX, and cytarabine 2/week till CNS clearance, then weekly x 4. 8 doses of rituximab 375mg/m2 were given on D1, 8 of C1-4 if CD20 was ≥20% by flow cytometry (FCM)...Ursodeoxycholic acid was given to all pts...Maintenance was initially with vincristine 2mg D1, prednisolone 50mg daily D1-5, 6-mercaptopurine 50mg BID & MTX 10mg/m2 weekly (POMP) for 3 years...Conclusion : mHCVD-InO ± Blina is an efficacious and tolerable regimen with promising PFS and OS benefit even on long-term F/U. Further reduction of chemo doses and assessment of mutations that increase risk of myeloid neoplasms,..."

Clinical • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • CNS Disorders • Epilepsy • Hematological Malignancies • Leukemia • Multiple Myeloma • Oncology • CD20 • CRLF2 • KMT2A • TP53

EFFECT OF MINIMAL RESIDUAL DISEASE GUIDED POSTTRANSPLANT 6-MERCAPTOPURINE AND METHOTREXATE MAINTENANCE ON PROGNOSIS OF HIGH-RISK PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA: A SINGLE-CENTER EXPERIENCE (EBMT 2026) - "To our knowledge, this is the first pediatric study to assess preemptive, flow-MRD-guided 6-MP/MTX maintenance after allo-SCT in high-risk ALL. This approach to relapse prevention in pediatric ALL may enhance survival with minimal toxicity and low cost; nevertheless, further research is needed for a full assessment of these potential approaches."

Clinical • Minimal residual disease • Post-transplantation • Residual disease • Acute Graft versus Host Disease • Acute Lymphocytic Leukemia • Graft versus Host Disease • Hematological Malignancies • Immunology • Leukemia • Pediatrics • Transplantation

Physicochemical characterization and clinical evaluation of 3D-printed subdivided tablets of 6-Mercaptopurine with broad dosage variations. (PubMed, Int J Pharm) - "Paired t-tests within each group revealed significant differences in white blood cell counts pre-treatment and post-treatment (pharmacist-splitting group: P < 0.01; 3D-printed group: P < 0.001), indicating that both groups exhibited pharmacological activity, with the 3D-printed group achieving improved control of hematological indices. Overall, SSE 3D printing technology enables accurate and safe individualized drug dosing."

Journal • Acute Lymphocytic Leukemia • Hematological Disorders • Hematological Malignancies • Leukemia • Oncology • Pediatrics

A case of intestinal Behçet disease in a deceased donor kidney transplantation recipient. (PubMed, Clin Transplant Res) - "The patient's symptoms improved after 2 weeks of therapy with colchicine, mesalazine, and mercaptopurine. This case highlights the rare, de novo development of intestinal BD years after kidney transplantation. Intestinal BD should be considered in transplant recipients presenting with unexplained abdominal pain or diarrhea."

Journal • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Pain • Transplantation

Prevalence of TPMT and NUDT15 diplotypes in Mexican children with B-cell acute lymphoblastic leukemia. (PubMed, Pharmacogenet Genomics) - "Approximately 28% of patients carried TPMT and/or NUDT15 variants associated with non-wild-type enzymatic activity, increasing the risk of mercaptopurine-induced myelotoxicity. Preemptive genotyping is essential to reduce toxicity, optimize treatment, and advance precision medicine in this population. Additionally, the two TPMT variants p.G126A and p.D137Y, currently not classified within Clinical Pharmacogenetics Implementation Consortium-defined star alleles, highlight the need for functional validation and potential clinical classification to improve pharmacogenetic interpretation in diverse populations."

Journal • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Hematological Malignancies • Leukemia • Oncology • Pediatrics • NUDT15

Correlation analysis of adverse reactions of liver injury caused by mercaptopurine in children with acute lymphoblastic leukemia (ChiCTR) - P=N/A | N=372 | Recruiting | Sponsor: Shenzhen Children’s Hospital; Shenzhen Children’s Hospital

New trial • Acute Lymphocytic Leukemia • Hematological Malignancies • Hepatology • Leukemia • Liver Failure • Oncology

TPMT/NUDT15 Preemptive Genotyping to Guide Precision 6-Mercaptopurine Dosing in Chinese Pediatric Patients with Acute Lymphoblastic Leukemia (ChiCTR) - P=N/A | N=200 | Not yet recruiting | Sponsor: Fujian Children's Hospital; Fujian Children's Hospital

New trial • Acute Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Oncology • Pediatrics

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Thiopurine Dosing Based on TPMT and NUDT15 Genotypes: 2025 Update. (PubMed, Clin Pharmacol Ther) - "Genetic variants in these genes are present in all world populations; however, their frequency varies by ancestry. In this updated guideline, we provide recommendations for adjusting starting doses of mercaptopurine, thioguanine, and azathioprine based on TPMT and NUDT15 genotypes, including for individuals with variants in both genes (updates on www.clinpgx.org)."

Biomarker • Journal • NUDT15

Synergistic Antitumor Potential of Propolis With 6‑Mercaptopurine and 5‑Fluorouracil. (PubMed, Cell Biochem Funct) - "Propolis serves as a prospective chemotherapeutic adjuvant that enhances the anticancer efficacy of 6-MP and 5-FU, allowing dose reduction, minimizing toxicity, and potentially overcoming drug resistance in breast cancer treatment. However, the therapeutic use of this synergistic technique requires confirmation via pharmacokinetic profiling, extensive vivo research, and considered clinical trials."

Journal • Breast Cancer • Oncology • Solid Tumor • CDK2

Mini-hyper-CVD plus inotuzumab ozogamicin, with or without blinatumomab, in the subgroup of older patients with newly diagnosed Philadelphia chromosome-negative B-cell acute lymphocytic leukaemia: long-term results of an open-label phase 2 trial. (PubMed, Lancet Haematol) - P1/2 | "Inotuzumab ozogamicin with or without blinatumomab added to low-intensity chemotherapy showed promising activity in terms of progression-free survival in older patients with B-cell acute lymphocytic leukaemia. Further attenuation of the chemotherapy regimen might improve tolerability while maintaining efficacy in older patients."

Journal • P2 data • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Febrile Neutropenia • Hematological Disorders • Hematological Malignancies • Hepatology • Leukemia • Neutropenia • Oncology • Thrombocytopenia • POMP

Development of Inotuzumab Ozogamicin and Blinatumomab for Frontline Treatment of Older Patients with Ph-Negative B-Cell Acute Lymphoblastic Leukemia (SOHO 2024) - "In the single-arm, phase II INITIAL-1 trial (median age 64 years), the GMALL group administered 3 cycles of InO with dexamethasone as remission induction therapy, followed by reduced-intensity chemotherapy, and then maintenance therapy with mercaptopurine and methotrexate...With 15 months of follow-up, the estimated 1-year OS and leukemia-free survival rates were 73% and 65%, respectively.7 Similarly, MD Anderson studied a reduced-dose InO in combination with mini-hyperCVD (dose-reduced cyclophosphamide, vincristine, and dexamethasone, alternating with methotrexate and cytarabine) regimen in older patients (median age 68 years)...Elimination of conventional chemotherapy by using highly active targeted agents is highly effective in Ph-positive ALL, and the preliminary results for InO and blinatumomab with either dose-reduced or no conventional chemotherapy support some of these approaches as valid options for the treatment of older patients in clinical practice. Given..."

Clinical • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Hematological Malignancies • Leukemia • Oncology • CD19 • CD22

Elderly ALL: Inotuzumab as Induction (SOHO 2024) - "The first induction cycle (21 days) consisted of InO 0.8 mg/m2 on day 1 and 0.5 mg/m2 on day 8 and day 15 in combination with dexamethasone 10 mg/m2 (days 7–8 and days 14–17) and one intrathecal ( i.th.) injection of methotrexate (MTX), cytarabine (AraC), and dexamethasone (Dex)...Patients who achieved CR/CRi after induction (observed CR/CRi rate was 90%) received 6 cycles of conventional consolidation and POMP (6-mercaptopurine, vincristine, methotrexate, and prednisone) maintenance...As of May 2024, data are available from a study (Alliance A041703) evaluating a chemotherapy-free regimen of InO and blinatumomab in 33 patients (median age: 71 years, range: 60–84) with newly diagnosed, Ph-negative, B-ALL...The opportunity to apply this therapy in an outpatient setting preserves the quality of life of patients. Ongoing and future clinical trials should address the optimal combination and sequence of conventional, targeted, and immune cell-based therapies to enable durable..."

Clinical • Acute Lymphocytic Leukemia • Oncology • CD22

Results of salvage therapy with mini-hyper-CVD and inotuzumab ozogamicin with or without blinatumomab in pre-B acute lymphoblastic leukemia. (PubMed, J Hematol Oncol) - P1/2 | "Low-intensity mini-Hyper-CVD plus inotuzumab with or without blinatumomab showed efficacy in patients with relapsed-refractory ALL, with better survival after the addition of blinatumomab. Trial registration The trial was registered on clinicaltrials.gov with the identifier NCT01371630."

Journal • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Bone Marrow Transplantation • Hematological Malignancies • Hepatology • Leukemia • Oncology • Transplantation

Development and Application of an LC-MS/MS Method for Simultaneous Quantification of Azathioprine and Its Metabolites: Pharmacokinetic and Microbial Metabolism Study of a Colon-Targeted Nanoparticle. (PubMed, Pharmaceuticals (Basel)) - " AZA, 6-mercaptopurine (6-MP), 6-methylmercaptopurine (6-MMP), and 6-thioguanine (6-TG) were quantified in positive ion mode, and 6-thiouric acid (6-TU) in negative ion mode. This method provides accurate and precise quantification of physiologically relevant concentrations of AZA and its metabolites (6-MP, 6-MMP, 6-TG, and 6-TU), offering a bioanalytical tool for the pharmacokinetic and gut microbiota metabolism studies of AZA formulations. These findings suggest that APZE is a promising drug delivery formulation."

Journal • PK/PD data • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease

Harnessing Purines: Anticancer Activity and Target-Specific Approaches. (PubMed, Med Chem) - "For the anti-cancer drugs, Purine-based compounds remain a versatile and evolving class. Their targeted design offers promising avenues for personalized cancer therapy, warranting further clinical exploration."

Journal • Hematological Disorders • Hematological Malignancies • Oncology • Solid Tumor

6-Mercaptopurine vs. Mycophenolate Mofetil in Autoimmune Hepatitis and Azathioprine Intolerance: A Multicenter Study. (PubMed, Clin Gastroenterol Hepatol) - "Both 6-MP and MMF were capable of maintaining biochemical response in patients with AIH who were intolerant to AZA, with no clear evidence of inferiority of either treatment. While MMF was generally better tolerated, 6-MP may present a safe and effective treatment option in women of reproductive age. In addition, therapy with 6-MP enables clinicians to monitor drug metabolite levels, titrate dosages, and monitor adherence."

Clinical • Journal • Autoimmune Hepatitis • Immunology • Inflammation

Hyper-CVAD and sequential blinatumomab for newly diagnosed Philadelphia chromosome-negative B-cell acute lymphocytic leukaemia: a single-arm, single-centre, phase 2 trial. (PubMed, Lancet Haematol) - P2 | "Front-line sequential chemotherapy with blinatumomab resulted in encouraging long-term survival. Future randomised studies should evaluate the routine incorporation of blinatumomab in the treatment of patients with Ph-negative B-cell acute lymphocytic leukaemia."

Journal • P2 data • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Hematological Malignancies • Infectious Disease • Inflammation • Oncology • Respiratory Diseases • POMP

SWOG 1318: A Phase II Trial of Blinatumomab Followed by POMP Maintenance in Older Patients With Newly Diagnosed Philadelphia Chromosome-Negative B-Cell Acute Lymphoblastic Leukemia. (PubMed, J Clin Oncol) - "Blinatumomab was well tolerated and effective in the treatment of older patients with newly diagnosed Ph chromosome-negative B-ALL, including patients with poor-risk cytogenetics. The 3-year disease-free survival and overall survival results are encouraging and suggest that this approach should be further explored."

Journal • P2 data • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Hematological Malignancies • Leukemia • Oncology • POMP

A density functional theory study of cyclophosphamide and purinethol adsorption on a covalent triazine framework (CTF-2) for drug delivery applications. (PubMed, Sci Rep) - "These studies shows how these drugs can be loaded and off-loaded using the CTF-2 carrier. This study demonstrates the potential of CTF-2, which is an innovative and promising drug delivery carrier in the treatment of various diseases."

Journal • Oncology • CEBPZ

Genetic Determinants of Hematopoietic Toxicity Risk in Thai Pediatric Patients Undergoing 6-Mercaptopurine Treatment. (PubMed, Clin Transl Sci) - "In conclusion, NUDT15 plays a more prominent role than TPMT in 6-MP-induced hematopoietic toxicity in Thai pediatric patients. Determining NUDT15 phenotypes is essential to ensure appropriate 6-MP dosage adjustments and to mitigate the risk of severe hematopoietic toxicity in this population."

Journal • Acute Lymphocytic Leukemia • Hematological Disorders • Hematological Malignancies • Leukemia • Neutropenia • Oncology • Pediatrics • NUDT15 • TPMT

High Dose Methotrexate Does Not Reduce the Risk of CNS Relapse in Children and Young Adults with Acute Lymphoblastic Leukaemia and Lymphoblastic Lymphoma. Results of the Randomised Phase III Study UKALL 2011 (ASH 2022) - "The aims were to reduce induction toxicity (R1: Short [14 days] vs Standard [28 days] dexamethasone), CNS relapse risk (R2IM: HD MTX (HDM) vs standard interim maintenance (SIM)) and maintenance morbidity (R2pulses: Vincristine (VCR)/dexamethasone pulses or not)...SIM was for 2 months with oral mercaptopurine/MTX, monthly pulses and single IT MTX in Regimens A and B, and 5 doses of escalating IV MTX (Capizzi) + VCR + 2 doses of Pegylated asparaginase in Regimen C. HDM was given at a dose of 5g/m2 x 4 doses 2 weeks apart, low dose 6-MP and 2 doses of Pegylated asparaginase (Regimen C only)...Although the 'no pulses' arm was non-inferior overall for BMR, further sub-group and toxicity analyses are to be performed and will presented at the meeting. Acknowledgements Children with Cancer, Blood Cancer (grant ref 09042) and Cancer Research UK funded the trial."

Clinical • P3 data • Acute Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Lymphoma • Oncology • T Acute Lymphoblastic Leukemia

Poverty and Relapse Risk in Children with Acute Lymphoblastic Leukemia: Children's Oncology Group Study AALL03N1 Report. (PubMed, Blood) - P=N/A | "A greater proportion of children living in extreme poverty were non-adherent to mercaptopurine (57.1% vs 40.9%, P=0.04); however, poor adherence did not completely explain the association between poverty and relapse risk. Future studies need to understand the mechanisms underlying the association between extreme poverty and relapse risk. Clinical Trial number: NCT00268528."

Journal • Acute Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Oncology

Pharmacogenomics of Thiopurine Drugs: A Bench-To-Bedside Success Story in Thailand. (PubMed, Clin Transl Sci) - "However, the composite effects of these genetic variants remain unexplored at the global scale. Proper large-scale studies with multi-ethnic patients can provide a clear understanding of the TPMT/NUDT15 association and would pave the way towards the optimization of thiopurine drugs to achieve precision medicine."

Biomarker • Journal • Review • Acute Lymphocytic Leukemia • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Inflammatory Arthritis • Inflammatory Bowel Disease • Leukemia • Lupus • Oncology • Rheumatoid Arthritis • Rheumatology • Systemic Lupus Erythematosus • NUDT15