Abstract
Background
Mercaptopurine-induced neutropenia can interrupt chemotherapy and expose patients to infection during childhood acute lymphoblastic leukemia (ALL) treatment. Previously, six candidate gene variants associated with mercaptopurine intolerance were reported. Herein, we investigated the association between the mean tolerable dose of mercaptopurine and these genetic variants in Taiwanese patients.
Methods
In total, 294 children with ALL were treated at the National Taiwan University Hospital from April 1997 to December 2017. Germline variants were analyzed for NUDT15, SUCLA2, TPMT, ITPA, PACSIN2, and MRP4. Mean daily tolerable doses of mercaptopurine in the continuation phase of treatment were correlated with these genetic variants.
Results
Mercaptopurine intolerance was significantly associated with polymorphisms in NUDT15 (P value < 0.0001). Patients with SUCLA2 variants received lower mercaptopurine doses (P value = 0.0119). The mean mercaptopurine doses did not differ among patients with TPMT, ITPA, MRP4, and PACSIN2 polymorphisms (P value = 0.9461, 0.5818, and 0.7951, respectively). After multivariable linear regression analysis, only NUDT15 variants retained their clinically significant correlation with mercaptopurine intolerance (P value < 0.0001).
Conclusion
In this cohort, the major genetic determinant of mercaptopurine intolerance was NUDT15 in Taiwanese patients.
Impact
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NUDT15 causes mercaptopurine intolerance in children with ALL.
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The NUDT15 variant is a stronger predictor of mercaptopurine intolerance than TPMT in a Taiwanese cohort. This finding is similar with studies performed on Asian populations rather than Caucasians.
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Pre-emptive genotyping of the patients’ NUDT15 before administering mercaptopurine may be more helpful than genotyping TPMT in Asians.
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Acknowledgements
We thank all the patients who participated in this study and their parents. We also acknowledge TPOG and the Childhood Cancer Foundation in Taiwan for their assistance in data collection and management. This work was supported by the Ministry of Science and Technology (No. 106-2314-B-002-199-) and the National Taiwan University Hospital (107-S3890). We gratefully acknowledge the financial support of the National Science Council of Taiwan, ROC.
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D.-S.W.: writing—original draft preparation, visualization, investigation, and data curation. C.-H.Y.: writing—original draft preparation, investigation, and data curation. Y.-H.C.: formal analysis, investigation, and data curation. C.-Y.L.: formal analysis. K.-H.L.: resources. S.-T.J.: resources. M.-Y.L.: resources. H.-H.C.: resources. S.-W.L.: supervision, writing—review and editing. D.-T.L.: Resources. H.-Y.C.: methodology, formal analysis. Y.-L.Y.: project administration, supervision, writing—review and editing, resources, conceptualization.
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Informed consent was obtained from the parents or legal guardians of the patients, and, in total, 294 patients were enrolled at the study’s initiation.
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Wang, DS., Yu, CH., Lin, CY. et al. Childhood acute lymphoblastic leukemia mercaptopurine intolerance is associated with NUDT15 variants. Pediatr Res 89, 217–222 (2021). https://doi.org/10.1038/s41390-020-0868-8
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DOI: https://doi.org/10.1038/s41390-020-0868-8
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