Pancreatitis Induced by 6-mercaptopurine and 6-thioguanine in Childhood Acute Lymphoblastic Leukemia

Jong Hyung Yoon; Jae Suk Baek; Eun Kyung Kim; Hyoung Jin Kang; Hee Young Shin; Hyo Seop Ahn

doi:10.5045/kjh.2008.43.1.53

Journal List > Korean J Hematol > v.43(1) > 1032803

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yoon, Baek, Kim, Kang, Shin, and Ahn: Pancreatitis Induced by 6-mercaptopurine and 6-thioguanine in Childhood Acute Lymphoblastic Leukemia

Case Report

Korean J Hematol 2008;43(1):53-57.

Published online: 19 March 2008

DOI: https://doi.org/10.5045/kjh.2008.43.1.53

Pancreatitis Induced by 6-mercaptopurine and 6-thioguanine in Childhood Acute Lymphoblastic Leukemia

Jong Hyung Yoon, M.D.¹, Jae Suk Baek, M.D.¹, Eun Kyung Kim, M.D.¹, Hyoung Jin Kang, M.D.^1,², Hee Young Shin, M.D.^1,², Hyo Seop Ahn, M.D.^1,^2,

¹Department of Pediatrics, Seoul, Korea

²Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Correspondence to：Hyo Seop Ahn, M.D. Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine 101, Daehangno, Jongno-gu, Seoul 110-769, Korea Tel: ＋82-2-2072-3625, Fax: ＋82-2-743-3455 E-mail: hsahn@snu.ac.kr

Received 26 October 2007 Revised 27 December 2007 Accepted 5 January 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although pancreatitis is known as a common complication during the treatment of acute lymphoblastic leukemia, acute pancreatitis that's induced by 6-mercaptopurine or 6-thioguanine is very uncommon. We experienced the case of an 11-year-old boy with consecutive acute pancreatitis, and this was induced by 6-mercaptopurine and 6-thioguanine during maintenance chemotherapy of childhood acute lymphoblastic leukemia. We report here on this along with a review of the pertinent literature.

Go to :

Keywords: Pancreatitis, 6-mercaptopurine, 6-thioguanine, Acute lymphoblastic leukemia

REFERENCES

1). Runzi M., Layer P. Drug-associated pancreatitis; facts and fiction. Pancreas. 1996. 13:100–9.

2). McBride CE., Yavorski RT., Moses FM., Solimando DA., Byrd JC. Acute pancreatitis associated with continuous infusion cytarabine therapy: a case report. Cancer. 1996. 77:2588–91.

3). Park JE., Kim KM., Seo JJ., Moon HN., Ghim T. Clinical features of pancreatitis in children with leukemia and lymphoma. Korean J Pediatr Hematol Oncol. 1999. 6:48–56.

4). Willert JR., Dahl GV., Marina NM. Recurrent mercaptopurine-induced acute pancreatitis: a rare complication of chemotherapy for acute lymphoblastic leukemia in children. Med Pediatr Oncol. 2002. 38:73–4.

5). Haber CJ., Meltzer SJ., Present DH., Korelitz BI. Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease. Gastroenterology. 1986. 91:982–6.

6). Cappell MS., Das KM. Rapid development of pancreatitis following reuse of 6-mercaptopurine. J Clin Gastroenterol. 1989. 11:679–81.

7). Sadoff J., Hwang S., Rosenfeld D., Ettinger L., Spigland N. Surgical pancreatic complications induced by L-asparaginase. J Pediatr Surg. 1997. 32:860–3.

8). Schwab M., Schäffeler E., Marx C, et al. Azathioprine therapy and adverse drug reactions in patients with inflammatory bowel disease: impact of thiopurine S-methyltransferase polymorphism. Pharmacogenetics. 2002. 12:429–36.

9). Bank L., Wright JP. 6-Mercaptopurine-related pancreatitis in 2 patients with inflammatory bowel disease. Dig Dis Sci. 1984. 29:357–9.

10). Dubinsky MC., Feldman EJ., Abreu MT., Targan SR., Vasiliauskas EA. Thioguanine: a potential alternate thiopurine for IBD patients allergic to 6-mercaptopurine or azathioprine. Am J Gastroenterol. 2003. 98:1058–63.

11). Alexander S., Dowling D. Azathioprine pancreatitis in inflammatory bowel disease and successful subsequent treatment with mercaptopurine. Intern Med J. 2005. 35:570–1.

12). Dubinsky MC., Vasiliauskas EA., Singh H, et al. 6-Thioguanine can cause serious liver injury in inflammatory bowel disease patients. Gastroenterology. 2003. 125:298–303.

13). Ravikumara M., Hill FG., Wilson DC, et al. 6-Thioguanine-related chronic hepatotoxicity and variceal haemorrhage in children treated for acute lymphoblastic leukaemia-a dual-centre experience. J Pediatr Gastroenterol Nutr. 2006. 42:535–8.

14). De Bruyne R., Portmann B., Samyn M, et al. Chronic liver disease related to 6-thioguanine in children with acute lymphoblastic leukaemia. J Hepatol. 2006. 44:407–10.

15). Teml A., Schaeffeler E., Herrlinger KR., Klotz U., Schwab M. Thiopurine treatment in inflammatory bowel disease: clinical pharmacology and implication of pharmacogenetically guided dosing. Clin Pharma-cokinet. 2007. 46:187–208.

Go to :

Fig. 1

Pancreas and biliary CT shows edema and reduced contrast of pancreas and small amount of fluid collection, which were consistent with acute pancreatitis.

undefined

Table 1.

Characteristics of three episodes of pancreatitis in this case

	First episode	Second episode	Third episode
Chemotherapy	CCG-1882C 1st IM	CCG-1882C maintenance	CCG-1882C maintenance
Medications	IV vincristine, MTX, SC L-asparaginase	Oral 6-MP, Pd, MTX, IV vincristine, IT HC, MTX, Ara-C	Oral 6-TG, Pd, MTX, IV vincristine, IT HC, MTX, Ara-C
Symptoms	Periumbilical/LUQ pain, vomiting	Epigastric/RUQ pain radiating to back, vomiting	Abdominal pain & discomfort, nausea, vomiting
Amylase/lipase	535/10,404U/L	543/3,229U/L	258/4,053U/L

Abbreviations: CCG, Children's Cancer Group; IM, interim maintenance; IV, intravenous; MTX, methotrexate; SC, subcutaneous; LUQ, left upper quadrant; 6-MP, 6-mercaptopurine; Pd, prednisolone; IT, intrathecal; HC, hydrocortisone; Ara-C, cytosine arabinoside; RUQ, right upper quadrant; 6-TG, 6-thioguanine.

TOOLS

Similar articles