mercaptopurine and Chronic-Disease

The evidence for testing thiopurine S-methyltransferase (TPMT) enzymatic activity or genotype before starting therapy with thiopurine-based drugs is unclear.. To examine the sensitivity and specificity of TPMT genotyping for TPMT enzymatic activity, reducing harm from thiopurine by pretesting, and the association of thiopurine toxicity with TPMT status in adults and children with chronic inflammatory diseases.. MEDLINE, EMBASE, the Cochrane Library, and Ovid HealthSTAR (from inception to December 2010) and BIOSIS and Genetics Abstracts (to May 2009).. Two reviewers screened records and identified relevant studies in English.. Data on patient characteristics, outcomes, and risk for bias were extracted by one reviewer and independently identified by another.. 54 observational studies and 1 randomized, controlled trial were included. Insufficient evidence addressed the effectiveness of pretesting. Genotyping sensitivity to identify patients with low and intermediate TPMT enzymatic activity ranged from 70.33% to 86.15% (lower-bound 95% CI, 54.52% to 70.88%; upper-bound CI, 78.50% to 96.33%). Sparse data precluded estimation of genotype sensitivity to identify patients with low to absent enzymatic activity. Genotyping specificity approached 100%. Compared with noncarriers, heterozygous and homozygous genotypes were both associated with leukopenia (odds ratios, 4.29 [CI, 2.67 to 6.89] and 20.84 [CI, 3.42 to 126.89], respectively). Compared with intermediate or normal activity, low TPMT enzymatic activity was significantly associated with myelotoxicity and leukopenia.. Available evidence was not rigorous and was underpowered to detect a difference in outcomes.. Insufficient evidence addresses the effectiveness of TPMT pretesting in patients with chronic inflammatory diseases. Estimates of the sensitivity of genotyping are imprecise. Evidence confirms the known associations of leukopenia or myelotoxicity with reduced TPMT activity or variant genotype.. Agency for Healthcare Research and Quality.

Topics: Chronic Disease; Genetic Testing; Genotype; Humans; Inflammation; Mercaptopurine; Methyltransferases; Purines; Sensitivity and Specificity

To examine whether pretreatment determination of thiopurine methyltransferase (TPMT) enzymatic activity (phenotyping) or TPMT genotype, to guide thiopurine therapy in chronic autoimmune disease patients, reduces treatment harms. Other objectives included assessing: preanalytic, analytic, and postanalytic requirements for TPMT testing; diagnostic accuracy of TPMT genotyping versus phenotyping; association of thiopurine toxicity with TPMT genotypic or phenotypic status; and costs of testing, care, and treating drug-associated complications.. MEDLINE®, EMBASE®, and Healthstar were searched from inception to May 2010; the Cochrane Library® to October 2009; and BIOSIS®, Genetics Abstracts, and EconLit™ to May 2009, for English language records.. A reviewer screened records, and a second reviewer verified exclusions and subsequent selection of relevant studies. Studies in patients with leukemia and organ transplant were excluded. Additionally, laboratories that provide TPMT analytical services were surveyed to assess means of TPMT testing in practice. Where possible, risk of bias was assessed using standard criteria. Meta-analyses estimated diagnostic sensitivity, and specificity; and odds ratios of associations.. 1790 titles or abstracts, and 538 full text records were screened. 114 observational studies and one RCT were included. Majority of studies were rated fair quality, except for diagnostic studies with 37 percent of studies rated poor. In general, there were few patients who were homozygous (or compound heterozygous) for TPMT variant alleles in the included studies limiting applicability. There is insufficient evidence examining effectiveness of pretesting in terms of reduction in clinical adverse events. Sufficient preanalytical data were available regarding preferred specimen collection, stability and storage conditions for TPMT testing. There was no clinically significant effect of age, gender, various coadministered drugs, or most morbidities (with the exception of renal failure and dialysis). TPMT phenotyping methods had coefficients of variation generally below 10 percent. TPMT genotyping reproducibility is generally between 95-100 percent. The sensitivity of genotyping to identify patients with low or intermediate TPMT enzymatic activity is imprecise, ranging from 70.70 to 82.10 percent (95 percent CI, lower bound range 37.90 to 54.00 percent; upper bound range 84.60 to 96.90 percent). Sensitivity of homozygous TPMT genotype to correctly identify patients with low to absent enzymatic activity was 87.10 percent (95 percent CI 44.30 to 98.30 percent). Genotyping specificity approached 100 percent. Leukopenia was significantly associated with low and intermediate enzymatic activity (low activity OR 80.00, 95 percent CI 11.5 to 559; and intermediate activity OR 2.96, 95 percent CI 1.18 to 7.42), and homozygous and heterozygous TPMT variant allele genotype (OR 18.60, 95 percent CI 4.12 to 83.60; and 4.62, 95 percent CI 2.34 to 9.16, respectively). In general, TPMT phenotyping costs less than genotyping, although estimates across studies are quite heterogeneous.. There is insufficient direct evidence regarding the effectiveness of pretesting of TPMT status in patients with chronic autoimmune diseases. Indirect evidence confirms strong association of leukopenia with lower levels of TPMT activity and carrier genotype already established in the literature.

Topics: Autoimmune Diseases; Chronic Disease; Female; Humans; Leukopenia; Male; Mercaptopurine; Methyltransferases; Reproducibility of Results

The clinical management of Crohn's disease can be considered in relation to the treatment of acute disease and the maintenance of remission. The medication used to achieve these two goals may or may not be the same. Some patients with mildly active disease may respond to high-dose (4 g/day) mesalazine (mesalamine), and 5-aminosalicylic acid may also be helpful in weaning a patient off steroids after treatment for a flare-up. However, the value of 5-aminosalicylic acid in maintaining remission in Crohn's disease remains controversial. Subgroups of patients may be helped: for example, patients with Crohn's disease who have experienced a relapse within the last 2 years may benefit. Steroids form the first-line therapy for acute episodes of inflammation but do not maintain remission. Azathioprine and mercaptopurine are the first-line drugs for the maintenance of remission in moderate to severe Crohn's disease, and by titrating the dose up from 2 mg/kg daily, some previously resistant patients will be brought into remission. One-half of patients who do not tolerate azathioprine will tolerate mercaptopurine. Methotrexate is effective in inducing and maintaining remission, and is useful for patients who fail azathioprine treatment. Thalidomide is not proven in controlled studies, but two open studies have demonstrated its efficacy. The optimal dose, however, remains to be defined. Purified liquid diets with food exclusion can induce remission in patients with active disease, but food exclusion is difficult to maintain long term. Infliximab can induce and maintain remission in patients resistant to other therapies, with two-thirds of patients initially responding to treatment. One-third go into remission and, of those who respond to a single treatment, approximately one-half maintain remission when treated regularly for a year. Infliximab is, however, associated with an increased risk of infection, and its effect on cancer incidence is uncertain. The development of antibodies against the drug is associated with a loss of effect and allergic infusion reactions. In summary, simple proven therapies should be used first, because of their safety and benefit in some patients. However, aggressive therapy should be used when needed.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Azathioprine; Chronic Disease; Crohn Disease; Humans; Infliximab; Mercaptopurine; Mesalamine; Methotrexate; Prognosis; Steroids; Thalidomide

Thioguanine derivatives, azathioprine and 6-mercaptopurine, represent major drugs in the treatment of chronic active inflammatory bowel disease. They are effective in two-thirds of the patients and safe over the long term in patients who can tolerate them (80-90%). Recent progress in understanding the metabolism of these drugs and its implication in clinical practice have brought up new tools and strategies that are proposed to optimize treatment. In particular, the measurement and characterization of key enzymes and metabolites may have clinical impact. Thus, thiopurine methyl transferase genotyping and activity measurement, as well as erythrocytes, 6-thioguanine nucleotides and 6-methyl mercaptopurine levels, may help in some situations of intolerance or inefficacy with these drugs. Indications for starting and stopping treatment with thioguanine derivatives are also discussed.

Topics: Azathioprine; Chronic Disease; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Mercaptopurine; Thioguanine

In the past years there have been many exciting developments in IBD management. New therapies and concepts of remission induction and of maintenance have been developed. This paper is intending to bring together the basic topics in patient-management in the various medical fields that represent the most accepted ways of therapies. The introduction deals with the most common aspects of Crohn's disease and that of the ulcerative colitis. It describes the treatment of ulcerative colitis according to the different groups of patients and the degree of activity. First it analyses the possible ways leading to the remission, then the prevention of relapse, lastly the other therapeutic options which have not been given any evidence of so far. The main standards of Crohn's disease therapy are presented on the bases of the small bowel Crohn's disease. After discussing the essential principles in treating the complications it carries on the treating of the large bowel Crohn's disease and then it is completed with the consideration of prevention of the relapse and the supportive therapeutic possibilities.

Topics: Acute Disease; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Azathioprine; Chronic Disease; Colitis, Ulcerative; Crohn Disease; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Mercaptopurine; Mesalamine; Prednisolone; Recurrence; Risk Factors; Severity of Illness Index; Sulfasalazine

Topics: Adult; Anti-Inflammatory Agents; Azathioprine; Child; Chronic Disease; Colectomy; Colitis, Ulcerative; Humans; Mercaptopurine; Steroids; Treatment Outcome

Topics: Adrenal Cortex Hormones; Aminoimidazole Carboxamide; Azathioprine; Chlorambucil; Chronic Disease; Hepatitis; Humans; Mercaptopurine; Penicillamine; Succinates; Vitamins

Topics: Azathioprine; B-Lymphocytes; Chronic Disease; Denmark; Drug Evaluation; Female; Glucocorticoids; Hepatitis; Humans; Immunity, Cellular; Immunosuppressive Agents; Liver Cirrhosis; Liver Diseases; Male; Mercaptopurine; Placebos; T-Lymphocytes

Topics: Acute Disease; Antineoplastic Agents; Chlorambucil; Chlorine; Chronic Disease; Daunorubicin; Dimethoate; Drug Therapy, Combination; Ethylamines; Glucocorticoids; Humans; Immunoglobulins; Immunosuppression Therapy; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Leukocyte Count; Lymphocytosis; Mercaptopurine; Methotrexate; Prednisolone; Remission, Spontaneous

Topics: Adrenal Cortex Hormones; Aspartate Aminotransferases; Azathioprine; Blood Proteins; Chronic Disease; Female; Hepatitis; Humans; Liver Cirrhosis; Liver Function Tests; Mercaptopurine; Prednisone; Rest; Serum Albumin; Serum Globulins; Time Factors

Topics: Acute Disease; Age Factors; Alcoholism; Azathioprine; Chemical and Drug Induced Liver Injury; Chronic Disease; Cortisone; Diet Therapy; Exchange Transfusion, Whole Blood; Halothane; Hepatic Encephalopathy; Hepatitis; Hepatitis A; Hepatitis B; Hepatitis B Antigens; Hospitalization; Humans; Liver Diseases; Liver Function Tests; Malabsorption Syndromes; Mercaptopurine; Prednisone; Prognosis; Pruritus

Topics: Anemia; Anemia, Aplastic; Animals; Blood Transfusion; Bone Marrow; Bone Marrow Cells; Cell Differentiation; Chronic Disease; Erythropoiesis; Erythropoietin; Humans; Immune Sera; Kidney; Kidney Diseases; Lipids; Mercaptopurine; Polycythemia Vera

Topics: Adrenal Cortex Hormones; Antimetabolites; Chronic Disease; Female; Humans; Liver Diseases; Lupus Erythematosus, Systemic; Male; Mercaptopurine; Neutrophils

Topics: Adrenal Cortex Hormones; Azathioprine; Chronic Disease; Diagnosis, Differential; False Positive Reactions; Hepatitis; Hepatitis A; Humans; Liver; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Mercaptopurine

Topics: Animals; Autoantibodies; Azathioprine; Carbon Tetrachloride; Cell Membrane Permeability; Cell Nucleus; Chronic Disease; Hepatitis; Humans; Immunosuppressive Agents; Liver; Lymphocytes; Mercaptopurine; Microscopy, Electron; Mitochondria, Liver; Rats

Topics: Acute Disease; Adrenal Cortex Hormones; Chronic Disease; Humans; Leukemia; Mercaptopurine; Methotrexate; Vincristine

At present only one large controlled study has indicated that parenteral methotrexate may be effective in chronic active Crohn's disease (CD).. To evaluate the effectiveness of oral methotrexate in chronic steroid-dependent CD.. Patients with active CD, who have received steroids and/or immunosuppressives for at least 4 months during the preceding 12 months and with a current Harvey-Bradshaw index of > or = 7 were studied.. Methotrexate (12.5 mg weekly) or 6-mercaptopurine (50 mg daily), or placebo were given during the 9 months of the trial in addition to steroids and 5-aminosalicylic acid as clinically indicated.. Eighty-four patients were included (methotrexate, 26 patients; 6-mercaptopurine, 32 patients; placebo, 26 patients). The proportion of patients entering first remission as well as the proportions of patients relapsing after first remission were not significantly different between the groups. The mean Harvey-Bradshaw index and the mean monthly steroid dose were also similar. However, when each patient was evaluated as his or her own control, the reduction in steroid dose, the general well being, and the reduction in abdominal pain were significantly better in the methotrexate treated patients.. Methotrexate at a weekly oral dose of 12.5 mg was found to be moderately better than 6-mercaptopurine and placebo in patients with chronic active CD.

Topics: Abdominal Pain; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Chronic Disease; Crohn Disease; Double-Blind Method; Evaluation Studies as Topic; Female; Follow-Up Studies; Health Status; Humans; Immunosuppressive Agents; Israel; Male; Mercaptopurine; Mesalamine; Methotrexate; Middle Aged; Placebos; Recurrence; Remission Induction; Treatment Outcome

Thioguanine (TG) has been shown as a safe alternative in adults with inflammatory bowel disease (IBD) who did not tolerate conventional thiopurines [azathioprine (AZA)/mercaptopurine]. However, data in pediatric IBD are scarce. Therefore, we aimed to assess the safety of TG as maintenance therapy.. A retrospective, multicenter cohort study of children with IBD on TG was performed in the Netherlands. TG-related adverse events (AE) were assessed and listed according to the common terminology criteria for AE.. Thirty-six children with IBD (median age 14.5 years) on TG (median dose 15 mg/day) were included in 6 centers. Five AE occurred during follow-up [pancreatitis (grade 3), hepatotoxicity (grade 3) (n = 2), Clostridium difficile infection (grade 2), and abdominal pain (grade 2)]. All patients (n = 8) with a previously AZA-induced pancreatitis did not redevelop pancreatitis on TG.. In pediatric IBD, TG seems a safe alternative in case of AZA-induced pancreatitis. Further research assessing long-term TG-related safety and efficacy is needed.

Topics: Adolescent; Adult; Azathioprine; Child; Chronic Disease; Cohort Studies; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Mercaptopurine; Pancreatitis; Retrospective Studies; Thioguanine

Nodular regenerative hyperplasia (NRH) has been associated with thiopurine therapy in patients with inflammatory bowel disease (IBD), but prevalence and prognosis of NRH remain unclear. This study is a cross-sectional search for NRH in IBD patients with long-term azathioprine or 6-mercaptopurine treatment.. Thirty-three IBD patients with continuous azathioprine/6-mercaptopurine treatment for at least 5 years were included. Laboratory tests, thiopurine metabolite levels, liver histology, MRI were examined for NRH and signs of portal hypertension.. NRH was not observed in this cohort of 33 patients. Nevertheless, some possibly related signs of vascular changes were found by MRI in three patients. Also, splenomegaly, which may be associated with portal hypertension, was found in one patient. No high thiopurine dose neither high metabolite levels were found in these patients.. No NRH was found in this group of IBD patients with long-term azathioprine/6-mercaptopurine treatment. Larger multicenter studies are needed to determine the prevalence of NRH in thiopurine-treated IBD patients.

Topics: Azathioprine; Chronic Disease; Cross-Sectional Studies; Humans; Hyperplasia; Hypertension, Portal; Inflammatory Bowel Diseases; Mercaptopurine; Prevalence

Topics: Adult; Allopurinol; Azathioprine; Chronic Disease; Dermatitis, Atopic; Drug Therapy, Combination; Eczema; Female; Foot Dermatoses; Guanine Nucleotides; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Prospective Studies; Thionucleotides; Time Factors; Treatment Outcome

Microscopic colitis (MC) is a common chronic diarrhoeal disease, and remission can be induced with budesonide. However, diarrhoea relapses frequently when budesonide is tapered and a few patients become budesonide intolerant.. To examine retrospectively the effect of azathioprine (AZA) and mercaptopurine (MP) in patients with chronic, active MC.. Data on all MC patients who received AZA or MP in the years 1997-2011 at three centres representing three countries were pooled for analysis. The indications for thiopurine therapy were frequent relapses after short-term treatment (N = 26), budesonide dependency on 6 mg (N = 15) and budesonide intolerance (N = 5). The response to thiopurine treatment was defined as clinical remission, intolerance or nonresponse.. Forty-six MC patients (32 CC and 14 LC), 32 female; median age 59 years (range: 36-83) with a median disease duration of 3 years (range: 0.5-18) were included. Thirteen patients (28%) achieved long-term clinical remission on AZA therapy. AZA failed in 31 patients (67%) due to intolerance and in 2 patients (4%) because of nonresponse. Thirteen of 31 AZA-intolerant patients were switched to MP and 6 patients (46%) obtained clinical remission. Thus, the overall response rate to thiopurines was 19/46 (41%). The main side effects were nausea/vomiting and abnormally elevated liver enzymes.. In this retrospective case series, the majority of chronic, active MC patients were intolerant to AZA leading to cessation of treatment. However, further studies are needed to explore the efficacy, acceptance, tolerance and safety of MP in patients with chronic, active MC refractory to budesonide.

Topics: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Azathioprine; Chronic Disease; Colitis, Microscopic; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Retrospective Studies; Treatment Outcome

The setting of chronic immunosuppression in inflammatory bowel disease (IBD) may promote the proliferation of Epstein-Barr virus-positive neoplastic clones. We report two rare cases of Epstein-Barr virus-associated lymphoproliferative disorder in IBD patients: one resembled lymphomatoid granulomatosis, and the other was a lymphoma resembling Hodgkin lymphoma. There are currently no guidelines for the prevention of lymphoproliferative disorder in IBD patients on immunosuppressive therapy.

Topics: Adult; Chronic Disease; Epstein-Barr Virus Infections; Fatal Outcome; Female; Herpesvirus 4, Human; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Lymphoproliferative Disorders; Male; Mercaptopurine

Topics: Anecdotes as Topic; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Colitis, Ulcerative; Diagnostic Errors; Disease Progression; Female; Gastrointestinal Hemorrhage; Hospitalization; Humans; Immunosuppressive Agents; Mercaptopurine; Mesalamine; Patient Acceptance of Health Care; Recurrence; Shame; Students; Treatment Outcome; Young Adult

Several treatment strategies are available for children with severe immune thrombocytopenic purpura (ITP) and other immune cytopenias refractory to initial therapies. 6-Mercaptopurine (6MP) is one option, however it has not been well studied in children, especially as a single agent, and no pediatric case series have been reported since 1970.. We reviewed the experience at our institution over 8 years, using 6MP as a steroid sparing treatment for children with ITP, auto-immune hemolytic anemia (AIHA) or Evans syndrome. A total of 29 pediatric patients were treated with 6MP from 2000 to 2007.. Response was defined as a rise in hemoglobin by at least 1.5 g/dl and to a level of 10 g/dl or greater in patients treated for anemia, or a platelet count >or=50 x 10(9)/L in patients treated for thrombocytopenia. We found an overall response rate of 83% among all patients. Fourteen percent of patients stopped drug because of side effects.. These results suggest that 6MP can be an effective single-agent treatment for refractory immune cytopenias in children. Prospective studies are warranted to determine long-term efficacy and toxicity and to more clearly define patient populations most likely to respond.

Topics: Child; Chronic Disease; Female; Hemoglobins; Humans; Male; Mercaptopurine; Nucleic Acid Synthesis Inhibitors; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Retrospective Studies; Salvage Therapy; Treatment Outcome

Topics: Chronic Disease; Mercaptopurine; Nucleic Acid Synthesis Inhibitors; Purpura, Thrombocytopenic, Idiopathic; Salvage Therapy

Some patients with ulcerative colitis (UC) require immunosuppressants as maintenance therapy.. To assess epidemiological, clinical and disease factors at diagnosis that predict immunosuppressant use in UC.. All UC patients diagnosed between 1992 and 2005 and currently managed in the inflammatory bowel disease (IBD) clinic were included. Forty-three patients who currently or previously received azathioprine (AZA) or mercaptopurine (MP) for UC were compared with 130 controls. Charts were reviewed and logistic regression analyses were applied to identify factors associated with AZA or MP use.. In univariate model, seven factors at diagnosis correlated with AZA use: male gender [odds ratio (OR) 2.2]; left-sided or extensive colitis or pancolitis (OR 8.7-14.1); systemic steroid use within the first 6 months of diagnosis (OR 5.1); more than 10 bowel movements daily (OR 6.4); persistent or mostly blood in stool (OR 2.8); endoscopic proven moderate to severe disease (OR 7.2-12.0) and requirement of hospitalization (OR 2.7) on diagnosis. In multivariate model, the first three factors were shown to be statistically significant.. Male gender, initial presentation with severe and extensive disease clinically and endoscopically, requirement of hospitalization on diagnosis or systemic steroids within 6 months of diagnosis are predictive factors for immunosuppressant use in UC.

Topics: Adult; Antimetabolites; Azathioprine; Case-Control Studies; Chronic Disease; Colitis, Ulcerative; Dose-Response Relationship, Drug; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Predictive Value of Tests; Risk Assessment; Severity of Illness Index; Sex Factors; Treatment Outcome

We report on a boy with refractory chronic idiopathic thrombocytopenic purpura (ITP) successfully treated with combination therapy composed of low-dose cyclosporin A (CsA), azathiopurine, and prednisolone. The patient was diagnosed as having ITP at 5 years of age, and received high-dose intravenous immunoglobulin (IVIG), followed by oral prednisolone, intravenous pulsed dexamethasone, oral cepharantin, and intermittent IVIG therapies. Because there were no or only transient responses to these medical therapies over 2 years, he was splenectomized. However, 3 months after the splenectomy, his platelet counts fell to below 10 x 10(3)/microl accompanied by wet purpura. We resumed low-dose intermittent IVIG treatment for 1 year without sustained efficacy. We then started combination therapy with CsA (2.5 mg/kg/day), azathiopurine (1.7 mg/kg/day), and prednisolone (0.8 mg/kg/day). Complete remission was achieved within 2 weeks and the platelet counts remained > 50 x 10(3)/microl even after tapering off the prednisolone and azathiopurine at 6 and 12 months, respectively and have moreover remained normal for more than 10 months after completion of 2 years of CsA treatment. There were no adverse events during the therapeutic course. This is the first pediatric case of ITP treated with CsA in Japan. Such combination therapy may be promising and tolerable for childhood ITP with splenectomy failure.

Topics: Child, Preschool; Chronic Disease; Cyclosporine; Drug Administration Schedule; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Salvage Therapy; Splenectomy; Time Factors; Treatment Outcome

Several studies have suggested a role of bone marrow stroma injury in long-term chemotherapy-induced hematopoietic failure. To evaluate whether bone marrow microenvironment is altered by chemotherapy for acute lymphoblastic leukemia (ALL) and to determine its contribution to postchemotherapy anemia, we investigated the ability of stroma from children receiving maintenance chemotherapy for ALL to support hematopoiesis. Long-term bone marrow cultures (LTBMC) were established with bone marrow cells either from ALL children under therapy (n = 24) or from control subjects (n = 19). Nonadherent cells and colony forming units-granulocytic monocytic (CFU-GM) output in LTBMC did not differ between patients and controls. In contrast, burst forming unit-erythroid (BFU-E) numbers were lower in patient LTBMC (p = 0.013). Co-cultures of normal CD34+ cells and preformed patient or control stromas showed significantly reduced hematopoietic supportive capabilities of patient stromas: both CFU-GM and BFU-E were reduced (p = 0.002 and 0.046, respectively). In addition, supernatants (SN) of patients' LTBMC inhibited normal BFU-E growth compared with SN of normal LTBMC. Transforming growth factor (TGF)-beta1 levels were increased in patient cultures (p = 0.0039) and inversely correlated with BFU-E produced in LTBMC (r = -0.36, p = 0.04). Neutralization of TGF-beta1 significantly increased the BFU-E output of patient LTBMC (p = 0.0078). In contrast, macrophage inflammatory peptide (MIP)-1alpha levels were lower in SN of patients compared with controls (p = 0.015). Thus, chemotherapy for ALL induces functional deregulation within bone marrow stromal cells with an increase in the growth-inhibiting factor TGF-beta1, together with a decrease in MIP-1alpha, which might contribute to hematopoietic toxicity.

Topics: Antibodies; Antigens, CD34; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Cells; Cells, Cultured; Chemokine CCL3; Chemokine CCL4; Child; Chronic Disease; Coculture Techniques; Cytokines; Erythroid Precursor Cells; Humans; Macrophage Inflammatory Proteins; Mercaptopurine; Methotrexate; Myeloid Progenitor Cells; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Stromal Cells; Transforming Growth Factor beta; Transforming Growth Factor beta1

Topics: Azathioprine; Chronic Disease; Colitis, Ulcerative; Cyclosporine; Humans; Immunosuppressive Agents; Mercaptopurine; Patient Selection; Time Factors

To evaluate compliance in children with acute lymphoblastic leukaemia (ALL).. Compliance was assessed through specific interviews, annotations from medical charts, and erythrocytic determination of 6-mercaptopurine metabolites.. A total of 39 patients who had concluded maintenance phase of chemotherapy were included in the study. Mothers were responsible for delivering 6-MP in 87% of cases. Thirty five interviewees said that medical prescription was well understood and that the main reason for non-compliance was forgetfulness. Non-compliance was detected through interviews (33.3% of the cases), reports from medical charts (30.7%), and drug determination (16.6%); 53.8% of children were found to be non-compliant. Non-compliance was significantly associated with chronic undernourishment. Although not statistically significant, there was a trend for the group of non-compliant children to be associated with low per capita family income. No significant associations of non-compliance with age at diagnosis, gender, parents' schooling level, number of family members, power consumption, and medians of absolute leucocyte or neutrophil blood counts were detected. A short follow up period precluded valid analysis on outcome. In the non-compliant group (n = 21), seven children relapsed, contrasting with three relapses in the compliant group (n = 18).. Results suggest that non-compliance is one of the mechanisms which underlies the adverse influence of socioeconomic factors on the outcome of children with ALL. Additional studies are necessary to confirm this hypothesis. Comprehensive approaches to the problem of non-compliance are urgently needed.

Topics: Adolescent; Antimetabolites, Antineoplastic; Biomarkers, Tumor; Blood Cell Count; Child; Child, Preschool; Chronic Disease; Female; Humans; Infant; Interviews as Topic; Male; Mercaptopurine; Mothers; Nutrition Disorders; Patient Compliance; Poverty; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence

Topics: Administration, Oral; Adult; Age Factors; Anti-Infective Agents; Azathioprine; Child; Chronic Disease; Ciprofloxacin; Colectomy; Colitis, Ulcerative; Controlled Clinical Trials as Topic; Diabetes Mellitus; Diagnosis, Differential; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Mercaptopurine; Methotrexate; Nutritional Physiological Phenomena; Pregnancy; Recurrence; Remission Induction; Risk Factors; Time Factors

Topics: Adult; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Azathioprine; Child; Chronic Disease; Contraindications; Crohn Disease; Endoscopy; Enzyme Inhibitors; Female; Folic Acid Antagonists; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Infliximab; Male; Mercaptopurine; Methotrexate; Mycophenolic Acid; Nutritional Physiological Phenomena; Placebos; Prednisone; Pregnancy; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence; Remission Induction; Retrospective Studies; Time Factors; Ultrasonography

: Azathioprine and mercaptopurine are commonly used in chronic active Crohn's disease. They share the disadvantage of a delayed onset of action and potentially serious side-effects, and are metabolized to thioguanine nucleotides which are thought to be the active metabolites. The direct use of 6-thioguanine may offer a more rapid and safer alternative. We conducted an open prospective study to investigate the efficacy and safety of 6-thioguanine in chronic active Crohn's disease.. : Thirty-seven patients with chronic active Crohn's disease and a Crohn's disease activity index of > 150 were enrolled in this study. Inclusion criteria were steroid dependence (n = 19), steroid refractoriness (n = 9) and/or intolerance (n = 16) or refractoriness (n = 6) to azathioprine. Patients were treated with 40 mg/day of 6-thioguanine for 24 weeks; a dose escalation to 80 mg was allowed at week 12. Remission was defined as a Crohn's disease activity index of < 150 associated with a decrease of > 70 points; response was defined as a decrease of > 70 points in the Crohn's disease activity index.. : In the intention-to-treat analysis, 13 of 37 patients achieved remission (35%). Twelve of these 13 patients achieved remission after 4 weeks. Fifty-seven per cent of patients (21/37) achieved a response. The mean Crohn's disease activity index decreased from 284 +/- 74 to 153 +/- 101. 6-Thioguanine was more effective in azathioprine-intolerant than in azathioprine-refractory patients. Twelve of 16 patients intolerant to azathioprine tolerated 6-thioguanine. Adverse events included phototoxicity, pancreatitis, headache, nausea, alopecia, arthralgia, minor infections and reversible elevation of transaminases. Six patients required discontinuation of medication, two because of leucopenia.. : In this patient group with chronic active Crohn's disease, 6-thioguanine appeared to be effective with acceptable short-term toxicity, but long-term controlled trials are clearly needed to further define its role.

Topics: Adult; Chronic Disease; Crohn Disease; Dose-Response Relationship, Drug; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Prospective Studies; Treatment Outcome

Antibody binding to living Chang liver cell was measured in sera from 71 patients with various chronic liver diseases using 125I-labelled protein A binding assay. The level of antibody binding to Chang liver cell was significantly elevated in sera from patients with chronic active hepatitis (CAH), chronic persistent hepatitis (CPH) and liver cirrhosis as compared to those from healthy donors, but not in sera from patients with fatty liver. There was no detectable antibody binding to HeLa cells in those sera. The antibody binding to Chang liver cell was blocked by a human liver specific protein (LSP) preparation. The levels of antibody binding to Chang liver cell were significantly higher in patients with CAH than patients with CPH. On the other hand, the level of antibody binding to Chang liver cell was significantly decreased in sera from patients with CAH after a treatment with prednisolone (PSL) for 2 months and a subsequent combined administration of 6MP and a maintenance dose of PSL for 1 month. These results suggest that antibodies to Chang liver cell are closely correlated with the activity of chronic liver disease and that PSL and 6MP treatment can reduce the level of the antibodies.

Topics: Antibodies; Antigen-Antibody Reactions; Cell Line; Chronic Disease; Humans; Immunoassay; Liver; Liver Diseases; Membrane Proteins; Mercaptopurine; Prednisolone; Proteins; Staphylococcal Protein A

Topics: Adult; Anabolic Agents; Chronic Disease; Cyclophosphamide; Dexamethasone; Drug Evaluation; Drug Therapy, Combination; Drug Tolerance; Erythrocyte Transfusion; Evaluation Studies as Topic; Female; Hemoglobinuria, Paroxysmal; Humans; Male; Mercaptopurine; Prednisolone

Topics: Aged; Animals; Chronic Disease; Cytarabine; DNA, Neoplasm; Humans; In Vitro Techniques; Leukemia, Lymphoid; Male; Mercaptopurine; Mice; Middle Aged; Neoplasms, Experimental; Ribonucleotides; RNA, Neoplasm

Topics: Antigen-Antibody Complex; Chronic Disease; Complement System Proteins; Cortisone; Dose-Response Relationship, Drug; Drug Therapy, Combination; Factor VIII; Glomerulonephritis; Humans; Lupus Erythematosus, Systemic; Mercaptopurine; Prednisolone; Streptococcal Infections

Possibility and necessity of the immunosuppressive treatment is considerably determined by the underlying pathologo-anatomical substrate. The uncertainty concerning the chances of the success of such a therapy for the individual patient at least still at present allows a latitude of estimation. From this results the demand for a particularly intensive conscience of the responsibility taken on by us in finding the decision.

Topics: Acute Disease; Antilymphocyte Serum; Azathioprine; Chlorambucil; Chronic Disease; Cyclophosphamide; Dactinomycin; Glomerulonephritis; Humans; Immunosuppressive Agents; Kidney Glomerulus; Mercaptopurine; Methotrexate

Autoimmune hemolytic anaemia (AIHA) in childhood is associated with antibodies produced by the patient himself, which coat his red cells causing their hemolysis. Although in some cases no underlying disease could be found, in the majority of children a virus etiology is apparent. There are very few reports regarding the use of treatment with immunsuppressive agents and the possible benefit. The article reports one case of AIHA. The patient developed at age 6 months a prolonged chronic form of AIHA complicated by thrombopenic purpura. The recent knowledge about pathogenesis, clinical phenomena, serology and prognosis is discussed. Treatment with corticosteroids, azathioprine or cyclophosphamide failed to benefit. Splenectomy and 6-mercaptopurin therapy (3 months) resulted in a complete remission.

Topics: Anemia, Hemolytic, Autoimmune; Autoantibodies; Azathioprine; Chronic Disease; Cortisone; Cyclophosphamide; Humans; Infant; Male; Mercaptopurine; Splenectomy; Virus Diseases

Antibody-dependent cellular cytotoxicity by peripheral blood mononuclear cells was evaluated in 25 patients with chronic glomerulonephritis before and after combined vinblastine-cyclophosphamide-6-mercaptopurine-prednisolone therapy. Purified peripheral blood mononuclear cells of the patients mediated normal killed activity before the treatment and a strong suppression of their cytotoxic capacity was observed after the therapy. The possible significance of the inhibitory effect of immunosuppressive cytostatic treatment on human antibody-dependent cellular cytotoxicity is discussed.

Topics: Adolescent; Adult; Antibody-Dependent Cell Cytotoxicity; Chronic Disease; Cyclophosphamide; Drug Therapy, Combination; Female; Glomerulonephritis; Humans; Male; Mercaptopurine; Middle Aged; Prednisolone; Vinblastine

Topics: Adolescent; Adult; Aged; Androgens; Anemia, Aplastic; Azathioprine; Chronic Disease; Cyclophosphamide; Glucocorticoids; Humans; Immunoglobulin G; Iron; Male; Mercaptopurine; Middle Aged; Vitamins

A series of 21 patients with active chronic hepatit diagnosed on the basis of clinical, biochemical and histological criteria, were treated by immunosuppressive cure--a combination of Prednison or Triamcinolon with 6-Mercaptopurin. The cure lasted for at least 12 months and attempts as its interruption usually brought about exacerbation of activity requiring further treatment reaching the total of more than 3 years, in some cases lasting for all the followed period of 7 years. There were no significant side effects requiring interruption. Immunosuppressive treatment remarkably improved biochemical indicators, particularly significant was the decrease in SGPT activity and hypergammaglobulinemia. The results were likewise good in HB-Ag positive patients, 8 of which are included in the series. The prognosis of chronic active hepatitis undergoing immunosuppressive treatment was mathematically estimated. Using the mathematical solution of biological problems the authors arrived at the probable survival of 5.5 to 6.5 years for their series of patients.

Topics: Chronic Disease; Drug Therapy, Combination; Follow-Up Studies; Hepatitis; Hepatitis B; Humans; Immunosuppressive Agents; Liver Function Tests; Mercaptopurine; Prednisone; Triamcinolone

Topics: Adrenal Cortex Hormones; Antilymphocyte Serum; Azathioprine; Chronic Disease; Drug Therapy, Combination; Female; Hepatitis; Humans; Immunosuppressive Agents; Male; Mercaptopurine

Topics: Adrenal Cortex Hormones; Adult; Azathioprine; Chronic Disease; Dactinomycin; Dermatomyositis; Female; Humans; Mercaptopurine; Methotrexate; Recurrence; Thymectomy

Topics: Adrenal Cortex Hormones; Antimetabolites; Azathioprine; Chloroquine; Chronic Disease; Hepatitis; Humans; Immobilization; Immunosuppression Therapy; Immunosuppressive Agents; Liver Function Tests; Medication Errors; Mercaptopurine; Recurrence; Rest

Topics: Antilymphocyte Serum; Azathioprine; Chronic Disease; Cyclophosphamide; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunosuppressive Agents; Long-Term Care; Mercaptopurine; Methotrexate; Multiple Sclerosis; Myelin Sheath; Nerve Tissue Proteins; Prednisolone; Prognosis; Tissue Extracts

Topics: Anti-Inflammatory Agents; Antimetabolites; Azathioprine; Cholagogues and Choleretics; Chronic Disease; Cortisone; Diuretics; Glucocorticoids; Hepatitis; Humans; Immunosuppressive Agents; Liver Function Tests; Mercaptopurine; Methylprednisolone; Prednisone

Topics: Adolescent; Adult; Antineoplastic Agents; Azathioprine; Chlorambucil; Chronic Disease; Cyclophosphamide; Female; Follow-Up Studies; Humans; Male; Mercaptopurine; Middle Aged; Nephritis; Remission, Spontaneous; Time Factors

Topics: Chronic Disease; Cortisone; Diet Therapy; Glucocorticoids; Hepatitis; Humans; Immunosuppressive Agents; Mercaptopurine

Topics: Azathioprine; Chronic Disease; Diet Therapy; Dietary Carbohydrates; Dietary Proteins; Female; Hepatitis; Hot Temperature; Humans; Liver; Liver Cirrhosis; Mercaptopurine; Middle Aged; Penicillamine; Prednisone; Pregnancy; Pregnancy Complications; Rest; Splenectomy

Topics: Adolescent; Adult; Aged; Azathioprine; Blood Cell Count; Blood Platelets; Chronic Disease; Cyclophosphamide; Female; Follow-Up Studies; Humans; Immunosuppression Therapy; Male; Mercaptopurine; Middle Aged; Prednisone; Purpura, Thrombocytopenic; Sex Factors; Splenectomy; Thioguanine

Topics: Adrenal Cortex Hormones; Autoimmune Diseases; Azathioprine; Chemical and Drug Induced Liver Injury; Cholestasis; Chronic Disease; Dermatomyositis; Female; Glomerulonephritis; Humans; Lupus Erythematosus, Systemic; Mercaptopurine; Polyarteritis Nodosa; Scleroderma, Systemic; Time Factors

Topics: Adrenal Cortex Hormones; Adult; Antimetabolites; Chronic Disease; Drug Combinations; Humans; Male; Mercaptopurine; Methotrexate; Middle Aged; Psoriasis; Recurrence; Remission, Spontaneous

Topics: Adult; Azathioprine; Chronic Disease; Female; Glucocorticoids; Hepatitis; Humans; Immunosuppressive Agents; Liver Cirrhosis, Biliary; Male; Mercaptopurine; Middle Aged; Time Factors

Topics: Antibodies; Azathioprine; Blood Platelets; Busulfan; Child; Child, Preschool; Chronic Disease; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Prednisone; Purpura, Thrombocytopenic

Topics: Abortion, Therapeutic; Adolescent; Busulfan; Chronic Disease; Female; Humans; Leukemia, Myeloid; Leukocyte Count; Long-Term Care; Mercaptopurine; Myelography; Pregnancy; Pregnancy Complications, Hematologic; Splenectomy; Splenomegaly

Topics: Anti-Inflammatory Agents; Azathioprine; Biopsy; Chlorambucil; Chronic Disease; Creatine; Cyclophosphamide; Glomerulonephritis; Humans; Immunosuppressive Agents; Indomethacin; Mercaptopurine; Prednisone; Proteinuria

Topics: Chronic Disease; Hepatitis; Hepatitis B Antigens; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Liver Cirrhosis; Liver Diseases; Lymphocyte Activation; Mercaptopurine; Prednisolone

Topics: Azathioprine; Chronic Disease; Diet Therapy; Hepatitis; Humans; Mercaptopurine; Prednisolone; Rest

Topics: Adolescent; Adult; Aged; Azathioprine; Chronic Disease; Female; Hepatitis; Humans; Liver Cirrhosis; Male; Mercaptopurine; Middle Aged

Topics: Azathioprine; Chronic Disease; Cortisone; Hepatitis; Hepatitis B virus; Immunoglobulin A; Immunoglobulin G; Immunoglobulins; Immunosuppression Therapy; Mercaptopurine; Prednisone; Recurrence

Topics: Adult; Azathioprine; Chronic Disease; Hepatitis; Humans; Male; Mercaptopurine; Prednisolone

Topics: Adrenal Cortex Hormones; Adult; Antimetabolites; Azathioprine; Chronic Disease; Female; Hepatitis A; Hepatitis B; Humans; Male; Mercaptopurine; Middle Aged; Penicillamine; Prognosis

Topics: Adrenocorticotropic Hormone; Azathioprine; Child; Chronic Disease; Cyclophosphamide; Glomerulonephritis; Glucocorticoids; Humans; Immunosuppressive Agents; Long-Term Care; Mercaptopurine; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisone; Remission, Spontaneous; Retrospective Studies

A patient with atypical acute leukaemia is described. This patient has, in addition, monoclonal IgG hyperglobulinaemia without myelomatous lesions and is living and well three years after diagnosis. The cell types found in the blood and in the bone marrow are atypical, and the histochemical findings are discussed. The relationship between monoclonal hypergammaglobulinaemia and malignant blood diseases is also discussed, and the literature on the subject reviewed.

Topics: Blood Platelets; Blood Protein Disorders; Blood Protein Electrophoresis; Bone Marrow Examination; Chronic Disease; gamma-Globulins; Humans; Hypergammaglobulinemia; Immunoelectrophoresis; Immunoglobulin G; Leukemia; Leukocyte Count; Male; Mercaptopurine; Middle Aged; Prednisolone

Topics: Antineoplastic Agents; Arthritis, Rheumatoid; Azathioprine; Chlorambucil; Chronic Disease; Collagen Diseases; Cyclophosphamide; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mercaptopurine; Methotrexate; Phytotherapy; Plants, Medicinal; Plants, Toxic; Podophyllum; Prednisolone; Spondylitis, Ankylosing; Thiotepa; Triaziquone

Topics: Autoimmune Diseases; Chronic Disease; Cortisone; Cyclophosphamide; Female; Hepatitis; Hepatitis A; Humans; Liver Cirrhosis; Long-Term Care; Lupus Erythematosus, Systemic; Mercaptopurine; Penicillamine; Tuberculosis, Hepatic

Topics: Adult; Chronic Disease; Hepatitis; Humans; Male; Mercaptopurine

Topics: Adolescent; Blood Cell Count; Bone Marrow; Bone Marrow Cells; Bone Marrow Examination; Child; Child, Preschool; Chronic Disease; Female; Glomerulonephritis; Humans; Kidney Diseases; Kidney Function Tests; Liver Function Tests; Male; Mercaptopurine; Nephrotic Syndrome; Pyelonephritis

Topics: Adrenal Cortex Hormones; Adult; Chronic Disease; Female; Hepatitis; Humans; Liver Function Tests; Male; Mercaptopurine; Middle Aged; Prognosis

Topics: Acidosis; Blood Pressure; Child; Chronic Disease; Cyclophosphamide; Diet, Sodium-Restricted; Dietary Proteins; Diuretics; Glomerulonephritis; Humans; Hypertension; Mercaptopurine; Nephrotic Syndrome; Potassium; Prednisone; Reserpine; Water-Electrolyte Balance

Topics: Adolescent; Child; Child, Preschool; Chlorambucil; Chronic Disease; Female; Glomerulonephritis; Humans; Male; Mercaptopurine; Prednisolone

Topics: Adolescent; Biopsy; Blood Protein Disorders; Child; Chronic Disease; Cortisone; Female; gamma-Globulins; Hepatitis; Hepatomegaly; Humans; Liver; Liver Diseases; Liver Function Tests; Liver Regeneration; Male; Mercaptopurine; Microscopy, Electron; Prednisone; Prognosis; Serum Albumin; Splenomegaly

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Agranulocytosis; Anti-Bacterial Agents; Blood Platelets; Bone Marrow; Chronic Disease; Cortisone; Female; Humans; Immunosuppressive Agents; Leukocyte Count; Male; Mercaptopurine; Middle Aged; Prednisone

Topics: Chronic Disease; Cyclophosphamide; Deoxyuridine; DNA; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukocyte Count; Leukocytes; Ligases; Mercaptopurine; Methotrexate; Nucleosides; Nucleotides; Phosphotransferases; Tetrahydrofolate Dehydrogenase; Thymidine Kinase

Topics: Acute Disease; Aged; Aneuploidy; Bone Marrow Diseases; Busulfan; Cell Transformation, Neoplastic; Chromosome Aberrations; Chromosome Disorders; Chronic Disease; Female; Humans; Leukemia, Myeloid; Mercaptopurine; Methotrexate; Prednisolone; Vincristine

Topics: Child; Child, Preschool; Chronic Disease; Female; Humans; Male; Mercaptopurine; Pneumonia

Topics: Adolescent; Adult; Autoimmune Diseases; Chronic Disease; Female; Hepatitis; Humans; Liver Cirrhosis; Male; Mercaptopurine; Middle Aged; Prednisone

Topics: Alanine Transaminase; Arthritis, Rheumatoid; Aspartate Aminotransferases; Chronic Disease; Hepatitis; Humans; Liver Function Tests; Male; Mercaptopurine; Middle Aged

Topics: Azathioprine; Child; Child, Preschool; Chlorambucil; Chronic Disease; Female; Glomerulonephritis; Humans; Immunosuppressive Agents; Infant; Male; Mechlorethamine; Mercaptopurine; Nephrosis, Lipoid

Topics: Adolescent; Antineoplastic Agents; Azathioprine; Child; Child, Preschool; Chlorambucil; Chronic Disease; Female; Glomerulonephritis; Humans; Male; Mechlorethamine; Mercaptopurine; Nephrotic Syndrome

Topics: Adolescent; Adult; Antimetabolites; Azaguanine; Azathioprine; Chronic Disease; Cyclophosphamide; Female; Hepatitis; Humans; Liver Cirrhosis; Male; Mercaptopurine; Middle Aged; Prednisone; Thioguanine

Topics: Acute Disease; Adult; Alanine Transaminase; Chronic Disease; Hepatitis; Hepatitis B; Humans; Liver Function Tests; Male; Mercaptopurine; Middle Aged

Topics: Acute Disease; Child; Chronic Disease; Cyclophosphamide; Diagnosis, Differential; Humans; Leukemia; Male; Mercaptopurine; Methotrexate; Middle Aged

Topics: Adolescent; Adult; Azathioprine; Chlorambucil; Chronic Disease; Glomerulonephritis; Humans; Immunosuppressive Agents; Indomethacin; Kidney; Mercaptopurine; Middle Aged; Peritoneal Dialysis; Potassium; Prednisone; Prognosis; Proteinuria; Seizures; Time Factors

Topics: Acute Disease; Antineoplastic Agents; Asparaginase; Chronic Disease; Cyclophosphamide; Daunorubicin; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Mercaptopurine; Methotrexate; Prednisone; Vincristine

Topics: Chronic Disease; Humans; Liver Diseases; Mercaptopurine

Topics: Acute Disease; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Azathioprine; Biliary Tract Diseases; Biopsy; Child; Child, Preschool; Cholestasis; Chronic Disease; Diagnosis, Differential; Female; Hepatitis; Hepatitis A; Humans; Infant; Infant, Newborn; Liver Cirrhosis; Liver Cirrhosis, Biliary; Male; Mercaptopurine; Middle Aged; Necrosis

Topics: Adult; Alanine Transaminase; Bilirubin; Blood Glucose; Chronic Disease; Female; Hepatitis; Humans; Liver Cirrhosis; Male; Mercaptopurine; Middle Aged; Prednisolone

Topics: Acute Disease; Adolescent; Adult; Azathioprine; Child; Chronic Disease; Female; Follow-Up Studies; Hepatitis; Humans; Liver; Liver Function Tests; Male; Mercaptopurine; Middle Aged; Prednisone; Prognosis

Topics: Adolescent; Antimetabolites; Antineoplastic Agents; Arthritis, Rheumatoid; Azathioprine; Betamethasone; Chronic Disease; Humans; Male; Mercaptopurine; Methotrexate; Middle Aged; Synovitis; Thiotepa

Topics: Animals; Busulfan; Chronic Disease; Leukemia, Myeloid; Mercaptopurine; Mitomycins; Rats

Topics: Adolescent; Adult; Aged; Chronic Disease; Humans; Mercaptopurine; Middle Aged; Purpura, Thrombocytopenic

Topics: Antimetabolites; Arthritis, Rheumatoid; Azathioprine; Chronic Disease; Feeding and Eating Disorders; Humans; Mercaptopurine; Methotrexate; Nausea; Time Factors

Topics: Adolescent; Blood Platelets; Blood Transfusion; Chronic Disease; Female; Humans; Infant; Male; Mercaptopurine; Prednisone; Thrombocytopenia; Vincristine

Topics: Biopsy; Blood Chemical Analysis; Chronic Disease; Hepatitis; Humans; Hydrazines; Injections, Intravenous; Mercaptopurine