Biomaterial Database

Childhood acute lymphoblastic leukemia mercaptopurine intolerance is associated with NUDT15 variants. 2021

Der-Shiun Wang, and Chih-Hsiang Yu, and Chien-Yu Lin, and Ya-Hsuan Chang, and Kai-Hsin Lin, and Dong-Tsamn Lin, and Shiann-Tarng Jou, and Meng-Yao Lu, and Hsiu-Hao Chang, and Shu-Wha Lin, and Hsuan-Yu Chen, and Yung-Li Yang

Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

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. 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. 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). In this cohort, the major genetic determinant of mercaptopurine intolerance was NUDT15 in Taiwanese patients. NUDT15 causes mercaptopurine intolerance in children with ALL. 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. Pre-emptive genotyping of the patients' NUDT15 before administering mercaptopurine may be more helpful than genotyping TPMT in Asians.

UI	MeSH Term	Description	Entries
D008780	Methyltransferases	A subclass of enzymes of the transferase class that catalyze the transfer of a methyl group from one compound to another. (Dorland, 28th ed) EC 2.1.1.	Methyltransferase
D009503	Neutropenia	A decrease in the number of NEUTROPHILS found in the blood.	Neutropenias
D011755	Pyrophosphatases	A group of enzymes within the class EC 3.6.1.- that catalyze the hydrolysis of diphosphate bonds, chiefly in nucleoside di- and triphosphates. They may liberate either a mono- or diphosphate. EC 3.6.1.-.	Pyrophosphatase
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000071184	Pharmacogenomic Variants	Naturally occurring genetic variations associated with drug response (e.g., dosage, extent and rate of metabolic processes). While these variants are not markers for GENETIC PREDISPOSITION TO DISEASE they influence PHARMACOKINETICS and pharmacodynamics and often occur on genes encoding drug metabolism enzymes and transporters (e.g., ANGIOTENSIN CONVERTING ENZYME; CYTOCHROME P-450 CYP2D6).	Pharmacogenetic Variants,Pharmacokinetic Genetic Variants,Genetic Variant, Pharmacokinetic,Genetic Variants, Pharmacokinetic,Pharmacogenetic Variant,Pharmacogenomic Variant,Pharmacokinetic Genetic Variant,Variant, Pharmacogenetic,Variant, Pharmacogenomic,Variants, Pharmacogenetic,Variants, Pharmacogenomic
D000964	Antimetabolites, Antineoplastic	Antimetabolites that are useful in cancer chemotherapy.	Antineoplastic Antimetabolites
D012189	Retrospective Studies	Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.	Retrospective Study,Studies, Retrospective,Study, Retrospective
D012307	Risk Factors	An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent.	Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D013624	Taiwan	Country in eastern Asia, islands bordering the East China Sea, Philippine Sea, South China Sea, and Taiwan Strait, north of the Philippines, off the southeastern coast of China. The capital is Taipei. The alternate country name is Republic of China.	Formosa,Republic of China
D015122	Mercaptopurine	An antimetabolite antineoplastic agent with immunosuppressant properties. It interferes with nucleic acid synthesis by inhibiting purine metabolism and is used, usually in combination with other drugs, in the treatment of or in remission maintenance programs for leukemia.	6-Mercaptopurine,1,7-Dihydro-6H-purine-6-thione,6-Mercaptopurine Monohydrate,6-Thiohypoxanthine,6-Thiopurine,6H-Purine-6-thione, 1,7-dihydro-,BW 57-323H,Leupurin,Mecaptopurine Anhydrous,Mercaptopurina Wellcome,Puri-Nethol,Purimethol,Purinethol,6 Mercaptopurine,6 Mercaptopurine Monohydrate,6 Thiohypoxanthine,6 Thiopurine,BW 57 323H,BW 57323H