4.6 SFGH am report pearls:CML and allopurinol

  • Warburg effect: the phenomenon of cancer cells relying on aerobic glycolysis for energy.  This is an inefficient way to generate ATP as compared to the usual use of mitochondrial oxidative phosphorylation and can result in elevated lactate.
  • Brad Lewis pearl:
    • White count at which symptoms of leukostasis are typically seen:
      • AML/ALL: 70-100,000
      • CML: 250,000
      • CLL: 500,000
  • allopurinol therapy and HLA typing:
    • HLA-B*58:01 allele is strongly associated with severe hypersensitivity reactions to allopurinol
      • This allele is most commonly found in Asian subpopulations, notably those of Korean, Han Chinese, or Thai descent


Dean L. Allopurinol Therapy and HLA-B*58:01 Genotype. 2013 Mar 26 [Updated 2016 Mar 16]. In: Medical Genetics Summaries [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2012-. Available from: http://www.ncbi.nlm.nih.gov/books/NBK127547/

Understanding the Warburg effect: the metabolic requirements of cell proliferation. Vander Heiden MG et al. Science. (2009)


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