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6-tioguanine + standard maintenance therapy is an experimental combination regimen investigated in the Phase 3 TEAM (Thiopurine Enhanced ALL Maintenance) trial, which is a sub-protocol of the ALLTogether1 master protocol. This treatment involves the addition of low-dose oral 6-thioguanine (tioguanine) to the standard maintenance backbone consisting of methotrexate and 6-mercaptopurine. The regimen is specifically designed for patients aged 0–45 years with newly diagnosed B-cell precursor or T-cell acute lymphoblastic leukemia (ALL) who are stratified into the intermediate risk-high (IR-high) group. The primary objective of adding tioguanine is to increase the levels of DNA-incorporated thioguanine nucleotides (DNA-TG), thereby enhancing the cytotoxic effect on leukemic cells and reducing the risk of relapse. The trial is led by the ALLTogether Consortium across multiple European countries.
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