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<p>Over the past decades, survival outcomes for childhood acute lymphoblastic leukaemia (ALL) have significantly improved. However, adverse drug reactions (ADRs), particularly those related to 6-mercaptopurine (6-MP), remain a major concern. Myelosuppression associated with 6-MP administration can lead to infections or treatment interruptions. Excessive 6-thioguanine (6-TGN) levels worsen neutropenia, while elevated 6-methylmercaptopurine (6-MMP) levels contribute to hepatotoxicity. This study investigates genetic variants influencing 6-MP response in children with ALL. Seventeen tagSNPs in key enzymes involved in 6-MP metabolism, GMPS, IMPDH1, XO, and ITPA, were analysed. Genetic data were correlated with clinical and pharmacological parameters in 280 ALL patients treated under DFCI ALL 05–001, 11–001, and 16–001 protocols at CHU Sainte-Justine. Outcomes included 6-MP dose intensity, 6-TGN and 6-MMP metabolite levels, and hematologic and hepatic toxicities during consolidation II and maintenance phases. Results revealed that the rs6710015 variant allele in the <i>XO</i> gene is linked to lower 6-TGN and higher 6-MMP levels, while rs1884725 variant allele in the same gene is correlated with reduced neutropenia and higher cumulative 6-MP doses. In contrast, two variants in the <i>IMPDH1</i> gene, rs2228075 and rs2278294, are correlated with more frequent neutropenia. These findings highlight novel genetic variants influencing 6-MP metabolism and toxicity in paediatric ALL patients.</p>

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Influence of xanthine oxidase and inosine monophosphate dehydrogenase polymorphisms on 6-mercaptopurine treatment response in pediatric acute lymphoblastic leukemia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月18日

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  • Zarina Sabirova,
  • Moncef Taki Eddine Boucetta,
  • Rania Razane Bensouyad,
  • Vincent Gagné,
  • Yves Théorêt,
  • Tiago Nava,
  • Jean Marie Leclerc,
  • Caroline Laverdière,
  • Daniel Sinnett,
  • Thai-Hoa Tran,
  • Maja Krajinovic

摘要

Over the past decades, survival outcomes for childhood acute lymphoblastic leukaemia (ALL) have significantly improved. However, adverse drug reactions (ADRs), particularly those related to 6-mercaptopurine (6-MP), remain a major concern. Myelosuppression associated with 6-MP administration can lead to infections or treatment interruptions. Excessive 6-thioguanine (6-TGN) levels worsen neutropenia, while elevated 6-methylmercaptopurine (6-MMP) levels contribute to hepatotoxicity. This study investigates genetic variants influencing 6-MP response in children with ALL. Seventeen tagSNPs in key enzymes involved in 6-MP metabolism, GMPS, IMPDH1, XO, and ITPA, were analysed. Genetic data were correlated with clinical and pharmacological parameters in 280 ALL patients treated under DFCI ALL 05–001, 11–001, and 16–001 protocols at CHU Sainte-Justine. Outcomes included 6-MP dose intensity, 6-TGN and 6-MMP metabolite levels, and hematologic and hepatic toxicities during consolidation II and maintenance phases. Results revealed that the rs6710015 variant allele in the XO gene is linked to lower 6-TGN and higher 6-MMP levels, while rs1884725 variant allele in the same gene is correlated with reduced neutropenia and higher cumulative 6-MP doses. In contrast, two variants in the IMPDH1 gene, rs2228075 and rs2278294, are correlated with more frequent neutropenia. These findings highlight novel genetic variants influencing 6-MP metabolism and toxicity in paediatric ALL patients.