{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT possible intermediate metabolizer and NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate 6-mercaptopurine at 20-50% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., < 75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be necessary. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}