Testmiljö
Observera att detta är en testmiljö för utveckling som inte ska användas som underlag för klinisk bedömning. Besök Janusmed här: https://janusmed.se

4/9/2025

Janusmed kön och genus

Janusmed kön och genus – Merkaptopurin Ebb

Janusmed kön och genus är ett kunskapsstöd som tillhandahåller information om köns- och genusaspekter på läkemedelsbehandling. Kunskapsstödet är avsedd främst för hälso- och sjukvårdspersonal. Texterna är generella och ska inte ses som behandlingsriktlinjer. Det är alltid behandlande läkare som ansvarar för patientens medicinering.

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Merkaptopurin Testmiljö

Merkaptopurin

Klass : C!

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Produkter

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Mercaptopurin-Medice, Merkaptopurin Ebb, Puri-nethol, Purimmun, Purine......

Mercaptopurin-Medice, Merkaptopurin Ebb, Puri-nethol, Purimmun, Purinethol, Xaluprine
ATC-koder

L01BB02

L01BB02
Substanser

merkaptopurin, merkaptopurinmonohydrat

merkaptopurin, merkaptopurinmonohydrat
Sammanfattning

Sämre behandlingsresultat har observerats hos manliga individer med akut lymfoblastisk leukemi (ALL) som fått merkaptopurinbehandling. Baserat på begränsade data kan kvinnligt kön vara associerat med en ökad risk för biverkningar av merkaptopurin. Pojkar med ALL kräver högre doser av merkaptopurin för att uppnå samma koncentrationer av den aktiva metaboliten, 6-TGN, vilket är kopplat till en något högre aktivitet hos enzymet TPMT (tiopurinmetyltransferas).

Merkaptopurinbehandling hos såväl kvinnor som män kan orsaka fosterskada och ska undvikas till flickor och kvinnor som kan tänkas bli gravida om inte en effektiv preventivmetod ska användas.

Sämre behandlingsresultat har observerats hos manliga individer med akut lymfoblastisk leukemi (ALL) som fått merkaptopurinbehandling. Baserat på begränsade data kan kvinnligt kön vara associerat med en ökad risk för biverkningar av merkaptopurin. Pojkar med ALL kräver högre doser av merkaptopurin för att uppnå samma koncentrationer av den aktiva metaboliten, 6-TGN, vilket är kopplat till en något högre aktivitet hos enzymet TPMT (tiopurinmetyltransferas). Merkaptopurinbehandling hos såväl kvinnor som män kan orsaka fosterskada och ska undvikas till flickor och kvinnor som kan tänkas bli gravida om inte en effektiv preventivmetod ska användas.
Background

Despite recent improvements in outcomes, sex-based disparities in acute lymphoblastic leukemia (ALL) persist. These disparities are primarily due to a higher rate of central nervous system (CNS) relapses in boys/men with B-cell ALL. A comprehensive survey conducted by the Children’s Oncology Group (North America, Australia, and New Zealand) includes patients with B-cell ALL (4463 males, 3739 females) and T-cell ALL (1161 males, 401 females, 1-31 years) [1]. Boys exhibited lower 5-year event-free survival (EFS) rates compared to girls (84.6% vs. 86.0%) and overall survival (OS) rates (91.3%  vs. 92.5%). This discrepancy was particularly prominent in boys with B-cell ALL, who had poorer EFS (HR 1.2; 95% CI 1.1-1.3) and OS (HR 1.2; 95% CI, 1.0-1.4). The inferior outcomes in boys with B-ALL were primarily attributed to a higher incidence of relapses (5-year cumulative incidence of 11.2%  vs. 9.6%), especially relapses involving the CNS (4.2% vs. 2.5%) [1]. 

Since chemotherapeutic agents share some adverse effects, evaluation of a particular substance sex-related adverse effects during c......

Visa hela bakgrundstexten

Despite recent improvements in outcomes, sex-based disparities in acute lymphoblastic leukemia (ALL) persist. These disparities are primarily due to a higher rate of central nervous system (CNS) relapses in boys/men with B-cell ALL. A comprehensive survey conducted by the Children’s Oncology Group (North America, Australia, and New Zealand) includes patients with B-cell ALL (4463 males, 3739 females) and T-cell ALL (1161 males, 401 females, 1-31 years) [1]. Boys exhibited lower 5-year event-free survival (EFS) rates compared to girls (84.6% vs. 86.0%) and overall survival (OS) rates (91.3%  vs. 92.5%). This discrepancy was particularly prominent in boys with B-cell ALL, who had poorer EFS (HR 1.2; 95% CI 1.1-1.3) and OS (HR 1.2; 95% CI, 1.0-1.4). The inferior outcomes in boys with B-ALL were primarily attributed to a higher incidence of relapses (5-year cumulative incidence of 11.2%  vs. 9.6%), especially relapses involving the CNS (4.2% vs. 2.5%) [1].  Since chemotherapeutic agents share some adverse effects, evaluation of a particular substance sex-related adverse effects during combination chemotherapy is complicated. Another factor that complicates the evaluation of chemotherapeutic treatments’ effect is a poorer prognosis in men compared to women of most oncologic diseases that affect both sexes [2, 3]. # Pharmacokinetics and dosing Mercaptopurine (6-MP) produces a primary active metabolite known as 6-thioguanine nucleotide (6-TGN), along with two inactive metabolites, 6-thiouracil and 6-methyl-mercaptopurine (6-MMP). The enzyme TPMT (thiopurine S-methyltransferase) plays a critical role in catalyzing the S-methylation of 6-MP. When there are defects in the TPMT gene, it results in reduced methylation and diminished inactivation of 6-MP. This, in turn, leads to elevated levels of 6-TGN, which can increase the risk of bone marrow toxicity [4]. Conversely, higher levels of 6-MMP are associated with potential liver toxicity [5]. An analysis of blood samples collected from 75 men and 30 women diagnosed with ALL revealed an 8.3% higher level of TPMT activity in men. The researchers suggest that this difference in TPMT activity might account for the increased relapse rates and poorer treatment outcomes observed in male individuals with ALL receiving 6-MP therapy [6]. The activity of TPMT in healthy Italian-Caucasian children less than 2 years old (37 boys, 42 girls ) was studied. On average TPMT activity was 9% higher in boys [7].  The concentration of 6-TGN active metabolites in red blood cells has been linked to cytotoxicity and prognosis in children with leukemia. Notably, boys required a greater amount of 6-MP to achieve the same range of 6-TGN concentrations as girls [8]. # Effects In a meta-analysis of randomized trials comparing 6-TGN to 6-MP in childhood ALL, data from individual patients were analyzed. The study included a total of 1096 boys and 901 girls, 1-18 years, in the 6-MP group. The frequency of CNS relapse in boys was twice as high as in girls (odds ratio 1.93, 95% CI 1.34-2.79) [9]. Between 1990 and 1996, a total of 44 boys and 14 girls diagnosed with high-risk ALL were treated with the AL90 regimen, which included various anticancer medications, including 6-MP. The 5-year event-free survival rate was significantly lower in boys (49%) versus girls (86%) [10]. In a study conducted by the Nordic Society for Pediatric Hematology and Oncology (NOPHO), children with non-B-cell ALL (165 boys, 192 girls) were examined. The study aimed to investigate the relationship between the concentration of cytotoxic metabolites of methotrexate and 6-MP within red blood cells during maintenance therapy and the risk of relapse. The findings revealed that higher concentrations of these metabolites and being female were predictive factors associated with a more favorable prognosis [11]. # Adverse effects A study examined relation of concentrations of 6-TGN, the active metabolite of 6-MP, and the side effect profile during long-term remission maintenance treatment for ALL (12 boys, 10 girls). Despite no significant difference in exposure to 6-MP, the girls developed 6-MP toxicity at lower doses. The correlation between TGN-concentration and toxicity was more significant in girls [12]. # Reproductive health issues 6-MP like most other anti-cancer drugs is not compatible with pregnancy. Therefore, it is recommended that fertile women and men use contraceptives during and for at least 3 months after use of 6-MP [4]. Swedish users, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept

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Läkemedel innehållande merkaptopurin (ATC-kod L01BB02) används huvudsakligen på sjukhus och därför saknas könsuppdelade användningsdata [13].
Referenser

Visa referenser

  1. Gupta S, Teachey DT, Chen Z, Rabin KR, Dunsmore KP, Larsen EC et al. Sex-based disparities in outcome in pediatric acute lymphoblastic leukemia: a Children's Oncology Group report. Cancer. 2022;128(9):1863-1870.

  2. Radkiewicz, C. Sex differences in cancer risk and survival. [dissertation]. Dept of Medical Epidemiology and Biostatistics: Karolinska Institutet; 2019.

  3. Edgren G, Liang L, Adami HO, Chang ET. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol. 2012;27(3):187-96.

  4. Puri-nethol (mercaptopurine). Summary of Product Characteristics. Swedish Medical Products Agency (MPA) [updated 2023-06-30, cited 2023-08-07]

  5. Dubinsky MC, Lamothe S, Yang HY, Targan SR, Sinnett D, Théorêt Y et al. Pharmacogenomics and metabolite measurement for 6-mercaptopurine therapy in inflammatory bowel disease. Gastroenterology. 2000;118(4):705-13.

  6. Klemetsdal B, Wist E, Aarbakke J. Gender difference in red blood cell thiopurine methyltransferase activity. Scand J Clin Lab Invest. 1993;53(7):747-9.

  7. Serpe L, Calvo PL, Muntoni E, D'Antico S, Giaccone M, Avagnina A et al. Thiopurine S-methyltransferase pharmacogenetics in a large-scale healthy Italian-Caucasian population: differences in enzyme activity. Pharmacogenomics. 2009;10(11):1753-65.

  8. Lennard L, Lilleyman JS. Variable mercaptopurine metabolism and treatment outcome in childhood lymphoblastic leukemia. J Clin Oncol. 1989;7(12):1816-23.

  9. Escherich G, Richards S, Stork LC, Vora AJ, Childhood Acute Lymphoblastic Leukaemia Collaborative Group (CALLCG). Meta-analysis of randomised trials comparing thiopurines in childhood acute lymphoblastic leukaemia. Leukemia. 2011;25(6):953-9.

  10. Ishii E, Eguchi H, Matsuzaki A, Koga H, Yanai F, Kuroda H et al. Outcome of acute lymphoblastic leukemia in children with AL90 regimen: impact of response to treatment and sex difference on prognostic factors. Med Pediatr Oncol. 2001;37(1):10-9.

  11. Schmiegelow K, Schrøder H, Gustafsson G, Kristinsson J, Glomstein A, Salmi T et al. Risk of relapse in childhood acute lymphoblastic leukemia is related to RBC methotrexate and mercaptopurine metabolites during maintenance chemotherapy Nordic Society for Pediatric Hematology and Oncology. J Clin Oncol. 1995;13(2):345-51.

  12. Lilleyman JS, Lennard L, Rees CA, Morgan G, Maddocks JL. Childhood lymphoblastic leukaemia: sex difference in 6-mercaptopurine utilization. Br J Cancer. 1984;49(6):703-7.

  13. Conise (INSIKT). Kalmar: eHälsomyndigheten. 2018 [cited 2021-11-18.]

  1. Gupta S, Teachey DT, Chen Z, Rabin KR, Dunsmore KP, Larsen EC et al. Sex-based disparities in outcome in pediatric acute lymphoblastic leukemia: a Children's Oncology Group report. Cancer. 2022;128(9):1863-1870.
  2. Radkiewicz, C. Sex differences in cancer risk and survival. [dissertation]. Dept of Medical Epidemiology and Biostatistics: Karolinska Institutet; 2019.
  3. Edgren G, Liang L, Adami HO, Chang ET. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol. 2012;27(3):187-96.
  4. Puri-nethol (mercaptopurine). Summary of Product Characteristics. Swedish Medical Products Agency (MPA) [updated 2023-06-30, cited 2023-08-07]
  5. Dubinsky MC, Lamothe S, Yang HY, Targan SR, Sinnett D, Théorêt Y et al. Pharmacogenomics and metabolite measurement for 6-mercaptopurine therapy in inflammatory bowel disease. Gastroenterology. 2000;118(4):705-13.
  6. Klemetsdal B, Wist E, Aarbakke J. Gender difference in red blood cell thiopurine methyltransferase activity. Scand J Clin Lab Invest. 1993;53(7):747-9.
  7. Serpe L, Calvo PL, Muntoni E, D'Antico S, Giaccone M, Avagnina A et al. Thiopurine S-methyltransferase pharmacogenetics in a large-scale healthy Italian-Caucasian population: differences in enzyme activity. Pharmacogenomics. 2009;10(11):1753-65.
  8. Lennard L, Lilleyman JS. Variable mercaptopurine metabolism and treatment outcome in childhood lymphoblastic leukemia. J Clin Oncol. 1989;7(12):1816-23.
  9. Escherich G, Richards S, Stork LC, Vora AJ, Childhood Acute Lymphoblastic Leukaemia Collaborative Group (CALLCG). Meta-analysis of randomised trials comparing thiopurines in childhood acute lymphoblastic leukaemia. Leukemia. 2011;25(6):953-9.
  10. Ishii E, Eguchi H, Matsuzaki A, Koga H, Yanai F, Kuroda H et al. Outcome of acute lymphoblastic leukemia in children with AL90 regimen: impact of response to treatment and sex difference on prognostic factors. Med Pediatr Oncol. 2001;37(1):10-9.
  11. Schmiegelow K, Schrøder H, Gustafsson G, Kristinsson J, Glomstein A, Salmi T et al. Risk of relapse in childhood acute lymphoblastic leukemia is related to RBC methotrexate and mercaptopurine metabolites during maintenance chemotherapy Nordic Society for Pediatric Hematology and Oncology. J Clin Oncol. 1995;13(2):345-51.
  12. Lilleyman JS, Lennard L, Rees CA, Morgan G, Maddocks JL. Childhood lymphoblastic leukaemia: sex difference in 6-mercaptopurine utilization. Br J Cancer. 1984;49(6):703-7.
  13. Conise (INSIKT). Kalmar: eHälsomyndigheten. 2018 [cited 2021-11-18.]
Uppdaterat

Litteratursökningsdatum: 9/7/2023

Litteratursökningsdatum: 9/7/2023
Fasstexter

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C! C!
C! C!

Merkaptopurin Testmiljö

Merkaptopurin

Klass : C!

Visa all info

Skriv ut

Kontakta oss

Produkter

Visa alla produkter

Mercaptopurin-Medice, Merkaptopurin Ebb, Puri-nethol, Purimmun, Purine......

Mercaptopurin-Medice, Merkaptopurin Ebb, Puri-nethol, Purimmun, Purinethol, Xaluprine
ATC-koder

L01BB02

L01BB02
Substanser

merkaptopurin, merkaptopurinmonohydrat

merkaptopurin, merkaptopurinmonohydrat
Sammanfattning

Sämre behandlingsresultat har observerats hos manliga individer med akut lymfoblastisk leukemi (ALL) som fått merkaptopurinbehandling. Baserat på begränsade data kan kvinnligt kön vara associerat med en ökad risk för biverkningar av merkaptopurin. Pojkar med ALL kräver högre doser av merkaptopurin för att uppnå samma koncentrationer av den aktiva metaboliten, 6-TGN, vilket är kopplat till en något högre aktivitet hos enzymet TPMT (tiopurinmetyltransferas).

Merkaptopurinbehandling hos såväl kvinnor som män kan orsaka fosterskada och ska undvikas till flickor och kvinnor som kan tänkas bli gravida om inte en effektiv preventivmetod ska användas.

Sämre behandlingsresultat har observerats hos manliga individer med akut lymfoblastisk leukemi (ALL) som fått merkaptopurinbehandling. Baserat på begränsade data kan kvinnligt kön vara associerat med en ökad risk för biverkningar av merkaptopurin. Pojkar med ALL kräver högre doser av merkaptopurin för att uppnå samma koncentrationer av den aktiva metaboliten, 6-TGN, vilket är kopplat till en något högre aktivitet hos enzymet TPMT (tiopurinmetyltransferas). Merkaptopurinbehandling hos såväl kvinnor som män kan orsaka fosterskada och ska undvikas till flickor och kvinnor som kan tänkas bli gravida om inte en effektiv preventivmetod ska användas.
Background

Despite recent improvements in outcomes, sex-based disparities in acute lymphoblastic leukemia (ALL) persist. These disparities are primarily due to a higher rate of central nervous system (CNS) relapses in boys/men with B-cell ALL. A comprehensive survey conducted by the Children’s Oncology Group (North America, Australia, and New Zealand) includes patients with B-cell ALL (4463 males, 3739 females) and T-cell ALL (1161 males, 401 females, 1-31 years) [1]. Boys exhibited lower 5-year event-free survival (EFS) rates compared to girls (84.6% vs. 86.0%) and overall survival (OS) rates (91.3%  vs. 92.5%). This discrepancy was particularly prominent in boys with B-cell ALL, who had poorer EFS (HR 1.2; 95% CI 1.1-1.3) and OS (HR 1.2; 95% CI, 1.0-1.4). The inferior outcomes in boys with B-ALL were primarily attributed to a higher incidence of relapses (5-year cumulative incidence of 11.2%  vs. 9.6%), especially relapses involving the CNS (4.2% vs. 2.5%) [1]. 

Since chemotherapeutic agents share some adverse effects, evaluation of a particular substance sex-related adverse effects during c......

Visa hela bakgrundstexten

Despite recent improvements in outcomes, sex-based disparities in acute lymphoblastic leukemia (ALL) persist. These disparities are primarily due to a higher rate of central nervous system (CNS) relapses in boys/men with B-cell ALL. A comprehensive survey conducted by the Children’s Oncology Group (North America, Australia, and New Zealand) includes patients with B-cell ALL (4463 males, 3739 females) and T-cell ALL (1161 males, 401 females, 1-31 years) [1]. Boys exhibited lower 5-year event-free survival (EFS) rates compared to girls (84.6% vs. 86.0%) and overall survival (OS) rates (91.3%  vs. 92.5%). This discrepancy was particularly prominent in boys with B-cell ALL, who had poorer EFS (HR 1.2; 95% CI 1.1-1.3) and OS (HR 1.2; 95% CI, 1.0-1.4). The inferior outcomes in boys with B-ALL were primarily attributed to a higher incidence of relapses (5-year cumulative incidence of 11.2%  vs. 9.6%), especially relapses involving the CNS (4.2% vs. 2.5%) [1].  Since chemotherapeutic agents share some adverse effects, evaluation of a particular substance sex-related adverse effects during combination chemotherapy is complicated. Another factor that complicates the evaluation of chemotherapeutic treatments’ effect is a poorer prognosis in men compared to women of most oncologic diseases that affect both sexes [2, 3]. # Pharmacokinetics and dosing Mercaptopurine (6-MP) produces a primary active metabolite known as 6-thioguanine nucleotide (6-TGN), along with two inactive metabolites, 6-thiouracil and 6-methyl-mercaptopurine (6-MMP). The enzyme TPMT (thiopurine S-methyltransferase) plays a critical role in catalyzing the S-methylation of 6-MP. When there are defects in the TPMT gene, it results in reduced methylation and diminished inactivation of 6-MP. This, in turn, leads to elevated levels of 6-TGN, which can increase the risk of bone marrow toxicity [4]. Conversely, higher levels of 6-MMP are associated with potential liver toxicity [5]. An analysis of blood samples collected from 75 men and 30 women diagnosed with ALL revealed an 8.3% higher level of TPMT activity in men. The researchers suggest that this difference in TPMT activity might account for the increased relapse rates and poorer treatment outcomes observed in male individuals with ALL receiving 6-MP therapy [6]. The activity of TPMT in healthy Italian-Caucasian children less than 2 years old (37 boys, 42 girls ) was studied. On average TPMT activity was 9% higher in boys [7].  The concentration of 6-TGN active metabolites in red blood cells has been linked to cytotoxicity and prognosis in children with leukemia. Notably, boys required a greater amount of 6-MP to achieve the same range of 6-TGN concentrations as girls [8]. # Effects In a meta-analysis of randomized trials comparing 6-TGN to 6-MP in childhood ALL, data from individual patients were analyzed. The study included a total of 1096 boys and 901 girls, 1-18 years, in the 6-MP group. The frequency of CNS relapse in boys was twice as high as in girls (odds ratio 1.93, 95% CI 1.34-2.79) [9]. Between 1990 and 1996, a total of 44 boys and 14 girls diagnosed with high-risk ALL were treated with the AL90 regimen, which included various anticancer medications, including 6-MP. The 5-year event-free survival rate was significantly lower in boys (49%) versus girls (86%) [10]. In a study conducted by the Nordic Society for Pediatric Hematology and Oncology (NOPHO), children with non-B-cell ALL (165 boys, 192 girls) were examined. The study aimed to investigate the relationship between the concentration of cytotoxic metabolites of methotrexate and 6-MP within red blood cells during maintenance therapy and the risk of relapse. The findings revealed that higher concentrations of these metabolites and being female were predictive factors associated with a more favorable prognosis [11]. # Adverse effects A study examined relation of concentrations of 6-TGN, the active metabolite of 6-MP, and the side effect profile during long-term remission maintenance treatment for ALL (12 boys, 10 girls). Despite no significant difference in exposure to 6-MP, the girls developed 6-MP toxicity at lower doses. The correlation between TGN-concentration and toxicity was more significant in girls [12]. # Reproductive health issues 6-MP like most other anti-cancer drugs is not compatible with pregnancy. Therefore, it is recommended that fertile women and men use contraceptives during and for at least 3 months after use of 6-MP [4]. Swedish users, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept

Visa hela försäljning på recept

Läkemedel innehållande merkaptopurin (ATC-kod L01BB02) används huvudsakligen på sjukhus och därför saknas könsuppdelade användningsdata [13].
Referenser

Visa referenser

  1. Gupta S, Teachey DT, Chen Z, Rabin KR, Dunsmore KP, Larsen EC et al. Sex-based disparities in outcome in pediatric acute lymphoblastic leukemia: a Children's Oncology Group report. Cancer. 2022;128(9):1863-1870.

  2. Radkiewicz, C. Sex differences in cancer risk and survival. [dissertation]. Dept of Medical Epidemiology and Biostatistics: Karolinska Institutet; 2019.

  3. Edgren G, Liang L, Adami HO, Chang ET. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol. 2012;27(3):187-96.

  4. Puri-nethol (mercaptopurine). Summary of Product Characteristics. Swedish Medical Products Agency (MPA) [updated 2023-06-30, cited 2023-08-07]

  5. Dubinsky MC, Lamothe S, Yang HY, Targan SR, Sinnett D, Théorêt Y et al. Pharmacogenomics and metabolite measurement for 6-mercaptopurine therapy in inflammatory bowel disease. Gastroenterology. 2000;118(4):705-13.

  6. Klemetsdal B, Wist E, Aarbakke J. Gender difference in red blood cell thiopurine methyltransferase activity. Scand J Clin Lab Invest. 1993;53(7):747-9.

  7. Serpe L, Calvo PL, Muntoni E, D'Antico S, Giaccone M, Avagnina A et al. Thiopurine S-methyltransferase pharmacogenetics in a large-scale healthy Italian-Caucasian population: differences in enzyme activity. Pharmacogenomics. 2009;10(11):1753-65.

  8. Lennard L, Lilleyman JS. Variable mercaptopurine metabolism and treatment outcome in childhood lymphoblastic leukemia. J Clin Oncol. 1989;7(12):1816-23.

  9. Escherich G, Richards S, Stork LC, Vora AJ, Childhood Acute Lymphoblastic Leukaemia Collaborative Group (CALLCG). Meta-analysis of randomised trials comparing thiopurines in childhood acute lymphoblastic leukaemia. Leukemia. 2011;25(6):953-9.

  10. Ishii E, Eguchi H, Matsuzaki A, Koga H, Yanai F, Kuroda H et al. Outcome of acute lymphoblastic leukemia in children with AL90 regimen: impact of response to treatment and sex difference on prognostic factors. Med Pediatr Oncol. 2001;37(1):10-9.

  11. Schmiegelow K, Schrøder H, Gustafsson G, Kristinsson J, Glomstein A, Salmi T et al. Risk of relapse in childhood acute lymphoblastic leukemia is related to RBC methotrexate and mercaptopurine metabolites during maintenance chemotherapy Nordic Society for Pediatric Hematology and Oncology. J Clin Oncol. 1995;13(2):345-51.

  12. Lilleyman JS, Lennard L, Rees CA, Morgan G, Maddocks JL. Childhood lymphoblastic leukaemia: sex difference in 6-mercaptopurine utilization. Br J Cancer. 1984;49(6):703-7.

  13. Conise (INSIKT). Kalmar: eHälsomyndigheten. 2018 [cited 2021-11-18.]

  1. Gupta S, Teachey DT, Chen Z, Rabin KR, Dunsmore KP, Larsen EC et al. Sex-based disparities in outcome in pediatric acute lymphoblastic leukemia: a Children's Oncology Group report. Cancer. 2022;128(9):1863-1870.
  2. Radkiewicz, C. Sex differences in cancer risk and survival. [dissertation]. Dept of Medical Epidemiology and Biostatistics: Karolinska Institutet; 2019.
  3. Edgren G, Liang L, Adami HO, Chang ET. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol. 2012;27(3):187-96.
  4. Puri-nethol (mercaptopurine). Summary of Product Characteristics. Swedish Medical Products Agency (MPA) [updated 2023-06-30, cited 2023-08-07]
  5. Dubinsky MC, Lamothe S, Yang HY, Targan SR, Sinnett D, Théorêt Y et al. Pharmacogenomics and metabolite measurement for 6-mercaptopurine therapy in inflammatory bowel disease. Gastroenterology. 2000;118(4):705-13.
  6. Klemetsdal B, Wist E, Aarbakke J. Gender difference in red blood cell thiopurine methyltransferase activity. Scand J Clin Lab Invest. 1993;53(7):747-9.
  7. Serpe L, Calvo PL, Muntoni E, D'Antico S, Giaccone M, Avagnina A et al. Thiopurine S-methyltransferase pharmacogenetics in a large-scale healthy Italian-Caucasian population: differences in enzyme activity. Pharmacogenomics. 2009;10(11):1753-65.
  8. Lennard L, Lilleyman JS. Variable mercaptopurine metabolism and treatment outcome in childhood lymphoblastic leukemia. J Clin Oncol. 1989;7(12):1816-23.
  9. Escherich G, Richards S, Stork LC, Vora AJ, Childhood Acute Lymphoblastic Leukaemia Collaborative Group (CALLCG). Meta-analysis of randomised trials comparing thiopurines in childhood acute lymphoblastic leukaemia. Leukemia. 2011;25(6):953-9.
  10. Ishii E, Eguchi H, Matsuzaki A, Koga H, Yanai F, Kuroda H et al. Outcome of acute lymphoblastic leukemia in children with AL90 regimen: impact of response to treatment and sex difference on prognostic factors. Med Pediatr Oncol. 2001;37(1):10-9.
  11. Schmiegelow K, Schrøder H, Gustafsson G, Kristinsson J, Glomstein A, Salmi T et al. Risk of relapse in childhood acute lymphoblastic leukemia is related to RBC methotrexate and mercaptopurine metabolites during maintenance chemotherapy Nordic Society for Pediatric Hematology and Oncology. J Clin Oncol. 1995;13(2):345-51.
  12. Lilleyman JS, Lennard L, Rees CA, Morgan G, Maddocks JL. Childhood lymphoblastic leukaemia: sex difference in 6-mercaptopurine utilization. Br J Cancer. 1984;49(6):703-7.
  13. Conise (INSIKT). Kalmar: eHälsomyndigheten. 2018 [cited 2021-11-18.]
Uppdaterat

Litteratursökningsdatum: 9/7/2023

Litteratursökningsdatum: 9/7/2023
Fasstexter

Visa fasstexter