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June 10, 1974

Allopurinol and Cytotoxic Agents

Author Affiliations

Burroughs Wellcome Co. Research Triangle Park, NC

JAMA. 1974;228(11):1371. doi:10.1001/jama.1974.03230360019012

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To the Editor.—  The publication of "Allopurinol and Cytotoxic Drugs," (227:1036, 1974) raised a number of questions concerning the use of allopurinol with cytostatic agents. The article described an increased incidence of "bone marrow depression" in patients with nonleukemic forms of malignancies who received allopurinol in combination with cytotoxic agents. The criteria were leukopenia or thrombocytopenia or both, and whether or not the physician believed there was an adverse effect.Cytotoxic drugs, by definition, cause depression of rapidly proliferating tissues, most commonly those elements cited in the article, leukocytes and thrombocytes. Some degree of leukopenia should be present to assure the clinician that optimal levels of the toxic drug are reaching the tumor. When results of toxicity studies are reported in which the base-line drugs are themselves cytotoxic, the magnitude of the leukopenia or thrombocytopenia in each group must be compared. Oncology is a clinical science that relies heavily on