Division of Medical Safety Sciences, National Institute of Health Sciences, Kanagawa, Japan.
Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
Br J Haematol. 2022 Oct;199(2):260-269. doi: 10.1111/bjh.18405. Epub 2022 Aug 12.
Inherited genetic variation is associated with 6-mercaptopurine (6-MP) dose reduction and frequent toxicities induced by 6-MP. However, the tolerable dose for 6-MP is not fully predicted by the known variation in NUDT15 and TPMT among Asian children with acute lymphoblastic leukaemia (ALL). We performed a genome-wide association study (GWAS) related to 6-MP dose among Japanese children with ALL. This GWAS comprised 224 patients previously enrolled in Tokyo Children's Cancer Study Group clinical studies with replication attempted in 55 patients. Genome-wide single nucleotide polymorphism (SNP) genotypes were evaluated for association with average 6-MP dose during the initial 168 days of maintenance therapy. Possible associations were observed across five gene-coding regions, among which only variants at 13q14.2 were significant and replicated genome-wide (rs116855232, NUDT15, β = -10.99, p = 3.7 × 10 ). Notable findings were observed for variants in AFF3 (rs75364948, p = 2.05 × 10 ) and CHST11 (rs1148407, p = 2.09 × 10 ), but were not replicated possibly due to small numbers. A previously reported candidate SNP in MTHFR was associated with higher average 6-MP dose (rs1801133, p = 0.045), and FOLH1 (rs12574928) was associated in an evaluation of candidate regions (p = 0.013). This study provides strong evidence that rs116855232 in NUDT15 is the genetic factor predominantly associated with 6-MP tolerable dose in children in Japan.
遗传变异与 6-巯基嘌呤(6-MP)剂量减少和 6-MP 诱导的频繁毒性有关。然而,在亚洲急性淋巴细胞白血病(ALL)儿童中,已知 NUDT15 和 TPMT 的变异并不能完全预测 6-MP 的耐受剂量。我们进行了一项与日本 ALL 儿童 6-MP 剂量相关的全基因组关联研究(GWAS)。该 GWAS 包括 224 名先前参加东京儿童癌症研究组临床研究的患者,并在 55 名患者中尝试了复制。在维持治疗的最初 168 天内,评估了全基因组单核苷酸多态性(SNP)基因型与平均 6-MP 剂量的关联。在五个基因编码区域中观察到了可能的关联,其中只有 13q14.2 上的变异是显著的,并在全基因组范围内复制(rs116855232,NUDT15,β=-10.99,p=3.7×10)。在 AFF3(rs75364948,p=2.05×10)和 CHST11(rs1148407,p=2.09×10)中观察到了显著的变异,但由于数量较少,没有复制。MTHFR 中先前报道的候选 SNP 与较高的平均 6-MP 剂量相关(rs1801133,p=0.045),并且在候选区域的评估中,FOLH1(rs12574928)也相关(p=0.013)。这项研究提供了强有力的证据,表明 NUDT15 中的 rs116855232 是与日本儿童 6-MP 耐受剂量主要相关的遗传因素。