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Biochemical Evidence for Synergistic Combination Treatment with Methotrexate and 6-Mercaptopurine in Acute Lymphoblastic Leukemia

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Acute Leukemias II

Abstract

Methotrexate (MTX) and 6-mercaptopurine (6 MP) are common antimetabolites in the treatment of acute lymphoblastic leukemia (ALL) since their introduction in 1947 and 1952 [1, 2]. Originally, these agents were administered separately. However, after empirical evidence for a potentiating efficacy of the combination of both in mice leukemia [3], MTX and 6 MP have also been used in combination in childhood ALL. The enhanced efficacy of combination treatment in children was demonstrated in a study of the Acute Leukemia Group B in 1961 [4].

This work was supported by the Dutch Queen Wilhelmina Cancer Foundation (KWF), grant NUKC 82-3.

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References

  1. Seeger DR, Smith JM Jr, Hultquist ME (1947) Antagonist for pteroylglutamic acid. J Am Chem Soc 69:2567

    Article  PubMed  CAS  Google Scholar 

  2. Elion G, Burgi E, Hitchings GH (1952) Studies on condensed pyrimidine systems. IX. The synthesis of some 6-substituted purines. J Am Chem Soc 74:411–414

    Article  CAS  Google Scholar 

  3. Law LW, Taormina V, Boyle PJ (1954) Response of acute lymphocytic leukemias to the purine antagonist 6-mercaptopurine. Ann N Y Acad Sci 60:244–250

    Article  PubMed  CAS  Google Scholar 

  4. Frei E III, Freireich EJ, Gehan E et al. (1961) Studies of sequential and combination antimetabolite therapy in acute leukemia:6-mercaptopurine and methotrexate. Blood 18:431–454

    Google Scholar 

  5. Riehm H, Feickert H-J, Lampert F (1986) Acute lymphoblastic leukemia. In:Voute PA, Barnett A, Bloom HJG et al. (eds) Cancer in children. Clinical management. Springer, Berlin Heidelberg New York, pp 101–118

    Google Scholar 

  6. Zimm S, Collins JM, Riccardi R et al. (1983) Variable bioavailability of oral mercaptopurine. Is maintenance chemotherapy in acute lymphoblastic leukemia being optimally delivered. N Engl J Med 308:1005–1009

    Article  PubMed  CAS  Google Scholar 

  7. Lennard L, Lilleyman JS (1987) Are children with lymphoblastic leukaemia given enough 6-mercaptopurine? Lancet ii:785–787

    Article  Google Scholar 

  8. Evans WE, Crom WR, Stewart CF et al. (1984) Methotrexate systemic clearance influences probability of relapse in children with standard-risk acute lymphocytic leukaemia. Lancet i:359–362

    Article  Google Scholar 

  9. Pinkerton CR, Welshman SG, Kelly JG et al. (1982) Pharmacokinetics of low-dose methotrexate in children receiving maintenance therapy for acute lymphoblastic leukaemia. Cancer Chemother Pharmacol 10:36–39

    Article  PubMed  CAS  Google Scholar 

  10. Zimm S, Ettinger LC, Holcenberg et al. (1985) Phase I and clinical pharmacological study of mercaptopurine administered as a prolonged intravenous infusion. Cancer Res 45:1869–1873

    PubMed  CAS  Google Scholar 

  11. Schouten TJ, De Abreu RA, Schretlen EDAM et al. (1986) 6-Mercaptopurine:high-dose 24-h infusions in goats. J Cancer Res Clin Oncol 112:61–66

    Article  PubMed  CAS  Google Scholar 

  12. Bökkerink JPM, Bakker MAH, Hulscher TW etal. (1986) Sequence-, time- and dose-dependent synergism of methotrexate and 6-mercaptupurine in malignant human T-lymphoblasts. Biochem Pharmacol 35:3549–3555

    Article  PubMed  Google Scholar 

  13. Bökkerink JPM, De Abreu RA, Bakker MAH etal. (1986) Dose-related effects of methotrexate on purine and pyrimidine nucleotides and on cell-kinetic parameters in MOLT-4 malignant human lymphoblasts. Biochem Pharmacol 35:3557–3564

    Article  PubMed  Google Scholar 

  14. Bökkerink JPM, Bakker MAH, Hulscher TW et al. (1988) Purine de novo synthesis as the basis of synergism of methotrexate and 6-mercaptopurine in human malignant lymphoblasts of different lineages. Biochem Pharmacol 37:2321–2327

    Article  PubMed  Google Scholar 

  15. Bökkerink JPM, De Abreu RA, Bakker MAH et al. (1988) Effects of methotrexate on purine and pyrimidine metabolism and cell- kinetic parameters in human malignant lymphoblasts of different lineages. Biochem Pharmacol 37:2329–2338

    Article  PubMed  Google Scholar 

  16. Bökkerink JPM, Damen FJM, Hulscher TW et al. 6-Mercaptopurine:cytotoxicity and bio-chemical pharmacology in human malignant lymphoblasts of different lineages. Biochem Pharmacol (to be published)

    Google Scholar 

  17. Webb JL (1963) Antagonism, summation, and synergism. In:Webb JL (ed) Enzyme and metabolic inhibitors, vol 1. Academic Press, New York, pp 507–510

    Google Scholar 

  18. Schouten TJ, De Abreu RA, De Bruijn CHMM et al. (1984) 6-Mercaptopurine pharmacokinetics in animals and preliminary results in children. Adv Exp Med Biol 165B:367–370

    Google Scholar 

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Bökkerink, J.P.M., Damen, F.J.M., Hulscher, M.W., Bakker, M.A.H., De Abreu, R.A. (1990). Biochemical Evidence for Synergistic Combination Treatment with Methotrexate and 6-Mercaptopurine in Acute Lymphoblastic Leukemia. In: Büchner, T., Schellong, G., Hiddemann, W., Ritter, J. (eds) Acute Leukemias II. Haematology and Blood Transfusion / Hämatologie und Bluttransfusion, vol 33. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-74643-7_20

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  • DOI: https://doi.org/10.1007/978-3-642-74643-7_20

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-50984-4

  • Online ISBN: 978-3-642-74643-7

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