{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}