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 tox...

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 d...