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Blood, 15 October 2003, Vol. 102, No. 8, pp. 2736-2740. Prepublished online as a Blood First Edition Paper on July 3, 2003; DOI 10.1182/blood-2002-08-2372. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-08-2372v1 102/8/2736    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Harms, D. O. Articles by Janka-Schaub, G. E. Search for Related Content PubMed PubMed Citation Articles by Harms, D. O. Articles by Janka-Schaub, G. E. Related Collections Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Thioguanine offers no advantage over mercaptopurine in maintenance treatment of childhood ALL: results of the randomized trial COALL-92 Dörthe O. Harms, Ulrich Göbel, Hans J. Spaar, Ulrike B. Graubner, Norbert Jorch, Peter Gutjahr, and Gritta E. Janka-Schaub, for the COALL Study Group From the Children's University Hospital, Hamburg, Germany; the Children's University Hospital, Düsseldorf, Germany; the Children's University Hospital, Munich, Germany; the Children's Hospital Prof-Hess, Bremen, Germany; the Children's Hospital Gilead, Bielefeld, Germany; and the Children's University Hospital, Mainz, Germany. The German cooperative study group for childhood acute lymphoblastic leukemia (COALL-92) was designed to examine the clinical effectiveness of thioguanine (TG) versus mercaptopurine (MP) in maintenance treatment of childhood acute lymphoblastic leukemia (ALL) in a randomized multicenter trial. TG and MP are prodrugs and have to be converted intracellularly to 6-thioguanine nucleotides (TGNs) for cytostatic activity. TG is converted into TGN in fewer steps and has been shown to be more cytotoxic in equimolar doses in vitro compared with 6-MP. Therefore, a higher effectiveness of TG in maintenance treatment was postulated. Of 521 patients enrolled into the protocol, 474 were randomized to receive either MP or TG during maintenance therapy in a daily oral dose. After a median observation time of 6.6 years, the probability of event-free survival was 79% ± 3% for the MP group (238 children) and 78% ± 3% in the TG group (236 patients). In spite of TGN levels, exceeding those of the MP group 7 times, treatment with TG did not improve the outcome but was more complicated to handle due to a specific toxicity profile of prolonged myelosuppression with marked thrombocytopenia. Therefore, MP should remain the preferred drug for maintenance treatment of ALL, unless other studies demonstrate superiority of TG in larger trials or selected patient groups. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: C.-H. Pui, D. Campana, D. Pei, W. P. Bowman, J. T. Sandlund, S. C. Kaste, R. C. Ribeiro, J. E. Rubnitz, S. C. Raimondi, M. Onciu, et al. Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation N. Engl. J. Med., June 25, 2009; 360(26): 2730 - 2741. [Abstract] [Full Text] [PDF] C.-H. Pui and W. E. Evans Treatment of Acute Lymphoblastic Leukemia N. Engl. J. Med., January 12, 2006; 354(2): 166 - 178. [Full Text] [PDF] A. Holleman, M. H. Cheok, M. L. den Boer, W. Yang, A. J.P. Veerman, K. M. Kazemier, D. Pei, C. Cheng, C.-H. Pui, M. V. Relling, et al. Gene-Expression Patterns in Drug-Resistant Acute Lymphoblastic Leukemia Cells and Response to Treatment N. Engl. J. Med., August 5, 2004; 351(6): 533 - 542. [Abstract] [Full Text] [PDF]

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