Common acute lymphocyte leukemia

Thiopurine methyltransferase methylates 6-mercaptopurine, a commonly used treatment for childhood acute lymphocytic leukemia, reducing its conversion to the active form of the drug. Approximately 10% of patients have intermediate enzyme activity, and 0.3% are deficient for TPMT activity. Intermediate activity patients have a greater incidence of thiopurine toxicity, whereas TPMT-deficient patients have severe or fatal hematological toxicity from 6-mercaptopurine therapy. In one study, patients deficient for TPMT tolerated only 7% of a 2.5-yr mercaptopurine treatment regimen. Patients with intermediate TPMT activity tolerated 65% of total weeks of therapy and patients with normal TPMT activity tolerated 84% of total weeks of therapy (3). 

Types of Hormones Adrenocorticosteroids Prednisone Prednisolone Others Primary Antineoplastic Indications(s) Acute lymphoblastic leukemia chronic lymphocytic leukemia Hodgkin disease Common Adverse Effects Adrenocortical suppression general catabolic effect on supporting tissues [see Chapter 29]... 

A. Glucocorticoids Prednisone is the most commonly used glucocorticoid in cancer chemotherapy. The steroid has applications in dmg regimens for acute and chronic lymphocytic leukemia. Hodgkin s disease (MOPP regimen), and other lymphomas. Toxicity is described in Chapter 39. 

Zidovudine (200 mg every 4 hours) is indicated in the management of patients with HIV infection who show evidence of impaired immunity. Trimethoprim-sulfamethoxazole, pyrimethamine, and acyclovir may be necessary for the management or prevention of opportunistic infections. Zidovudine (3 -azido-3 -deoxythymidine, commonly referred to as AZT) is a thymidine analog with antiviral activity against HIV-1, HIV-2, human T-lymphotropic (or leukemia) virus (HTLV)-I, and other retroviruses. Low concentrations (<0.001 to 0.04 pg/ml) inhibit acute HIV-1 infection in human T-cell lines and peripheral blood lymphocytes. Zidovudine is less active in human monocyte-macrophages or quiescent cells but inhibits HIV replication in human brain macrophages. Zidovudine is also inhibitory for HBV and EBV... 

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