You have been asked to direct a pharmacogenetics testing laboratory in a hospital with many transplant patients who receive mercaptopurine derivatives to control transplant rejection.Which of the following enzyme phenotyping or genotyping services would be the highest priority to establish initially?

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The highest priority would be to establish TPMT genotyping. TPMT deficiency is a major risk factor for severe toxicity from mercaptopurine derivatives, including life-threatening myelosuppression. Identifying patients with TPMT deficiency would allow for appropriate dose adjustments or alternative therapies. N-acetyltransferase genotyping, CYP1A1 genotyping, and CYP2D6 phenotyping are not directly relevant to mercaptopurine derivative metabolism and toxicity.

You Have Been Asked to Direct a Pharmacogenetics Testing Laboratory