Objective To investigate the effect of single nucleotide polymorphisms of six related genes SLCO1B1, SLC19A1, ABCC2, ABCB1, FPGS, and GGH in the pathway of methotrexate (MTX) action on the adverse effects of myelosuppression caused by MTX in patients with primary central nervous system lymphoma (PCNSL).
Methods DNA samples from 121 patients with PCNSL were genotyped by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Patient demographics and corresponding clinical information were obtained from the electronic medical record system. The χ2 test and multivariate logistic regression analysis were used to explore the effect of single nucleotide polymorphisms on the patients' myelosuppression after chemotherapy, respectively.
Results In 121 patients with a total of 508 courses, 186 courses (36.6%) experienced myelosuppressive adverse reactions. Single factor analysis showed that the single nucleotide polymorphisms of SLCO1B1 rs2306283 and GGH rs2305558 had an effect on the incidence of myelosuppression due to MTX (P<0.05). Logistic regression analysis showed that the SNP of SLCO1B1 rs2306283 still had an effect on the incidence of MTX-induced myelosuppression (OR=1.542, 95%CI: 1.040 to 2.287, P=0.031).
Conclusion The GG genotype of SLCO1B1 rs2306283 may serve as an independent risk factor for predicting MTX-induced myelosuppression and provide basis for individualized drug therapy of MTX.
1.Kanderi T, Chan Gomez J, Puthenpura MM, et al. Pancytopenia as a complication of low-dose methotrexate in a septuagenarian: a rare presentation[J]. Cureus, 2020, 12(6): e8492. DOI: 10.7759/cureus.8492.
2.王振华, 袁燕, 吴婷, 等. 安全使用大剂量甲氨蝶呤治疗原发性中枢神经系统淋巴瘤1例分析[J]. 上海医药, 2021, 42(15): 3-4,64. [Wang ZH, Yuan Y, Wu T, et al. Safe administration of high-dose methotrexate in treatment of a patient with primary central nervous system lymphoma[J]. Shanghai Medical & Pharmaceutical Journal, 2021, 42(15): 3-4, 64.] DOI: 10.3969/j.issn.1006-1533. 2021.15.002.
3.Fox E, Busch C, Debernardo A, et al. A pharmacologically-based approach to high dose methotrexate administration to investigate nephrotoxicity and acute kidney injury biomarkers in children and adolescents with newly diagnosed osteosarcoma[J]. Cancer Chemother Pharmacol, 2021, 87(6): 807-815. DOI: 10.1007/s00280-021-04248-8.
4.Lui G, Treluyer JM, Fresneau B, et al. A pharmacokinetic and pharmacogenetic analysis of osteosarcoma patients treated with high-dose methotrexate: data from the OS2006/Sarcoma-09 trial[J]. J Clin Pharmacol, 2018, 58(12): 1541-1549. DOI: 10.1002/jcph.1252.
5.Huang S, Jin L, Yang J, et al. Study on relationships of tumor status and gene polymorphism with blood concentration of mtx and toxicities in 63 pediatric mature B cell lymphoma in Chinese population[J]. Technol Cancer Res Treat, 2021, 20: 1533033821995288. DOI: 10.1177/1533033821995288.
6.Chang X, Guo Y, Su L, et al. Influence of MTHFR C677T polymorphism on high-dose methotrexate-related toxicity in patients with primary central nervous system diffuse large B-cell lymphoma[J]. Clin Lymphoma Myeloma Leuk, 2021, 21(2): 91-96. DOI: 10.1016/j.clml.2020.08.020.
7.Choi YJ, Park H, Lee JS, et al. Methotrexate elimination and toxicity: MTHFR 677C>T polymorphism in patients with primary CNS lymphoma treated with high-dose methotrexate[J]. Hematol Oncol, 2017, 35(4): 504-509. DOI: 10.1002/hon.2363
8.Han J, Liu L, Meng L, et al. Effect of polymorphisms of ABCB1 and MTHFR on methotrexate-related toxicities in adults with hematological malignancies[J]. Front Oncol, 2021, 11: 759805.DOI: 10.3389/fonc.2021.759805.
9.Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127(20): 2375-2390. DOI: 10.1182/blood-2016-01-643569.
10.National Institutes of Health, National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) v 5.0. 2017[EB/OL]. (2017)[2021-07-01]. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf.
11.Bruno A, Boisselier B, Labreche K, et al. Mutational analysis of primary central nervous system lymphoma[J]. Oncotarget, 2014, 5(13): 5065-5075. DOI: 10.18632/oncotarget.2080.
12.Shahrure ZM, Irshaid YM, Mustafa KN, et al. SLCO1B1 gene polymorphisms (rs2306283 and rs4149056) and statin-induced myopathy in jordanian diabetics[J]. Curr Rev Clin Exp Pharmacol, 2021, 16(3): 281-288. DOI: 10.2174/1574884715666200827105612.
13.Liuykeviciene R, Vilkeviciute A, Slavinskaite A, et al. Evaluation of serum SLCO1B1 levels and genetic variants of SLCO1B1 rs4149056 and rs2306283 in patients with early and exudative age-related macular degeneration[J]. Gene, 2018, 676: 139-145. DOI: 10.1016/j.gene.2018.07.031.
14.Gonzalez-ibarra F, Eivaz-mohammadi S, Surapaneni S, et al. Methotrexate induced pancytopenia[J]. Case Rep Rheumatol, 2014, 2014: 679580.DOI: 10.1155/2014/679580.
15.Salamoon M, Hussein T, Kenj M, et al. High-dose methotrexate, high-dose cytarabine and temozolomide for the treatment of primary central nervous system lymphoma (PCNSL)[J]. Med Oncol, 2013, 30(4): 690. DOI: 10.1007/s12032-013-0690-9.
16.Sun K, Tao HW, Ding TL, et al. Risk factors for high-dose methotrexate associated toxicities in patients with primary central nervous system lymphoma[J]. J Clin Pharm Ther, 2022, 47(12): 2196-204.