How do you mitigate 6-MP-induced GI toxicity in pediatric and AYA patients with leukemia?

This is a great question as GI toxicities are commonly encountered in children, adolescents, and young adults being treated with 6MP including elevated transaminases, pancreatitis, and hypoglycemia. These GI toxicities are likely due to a skewing of 6MP metabolites with an accumulation of the GI toxic 6MMP metabolite, and away from the anti-leukemic 6TGN metabolite.

I think while the answer of how to manage such toxicities is still somewhat debatable, there are some strategies that have proven su...

I agree with Dr. @Dr. First Last's answer and have used allopurinol with reduced dose mercaptopurine in several patients with unacceptable GI toxicity, with good results.

That being said, I have always wondered what we know about the leukemia outcome for such patients. In the NOPHO group, they have done extensive work on optimizing maintenance therapy with mercaptopurine and methotrexate. They make the point that they believe the downstream target of mercaptopurine and methotrexate therapy is the...