Hepatic sinusoidal obstruction syndrome and short-term application of 6-thioguanine in pediatric acute lymphoblastic leukemia Academic Article uri icon

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abstract

  • AbstractLong-term treatment with 6-thioguanine (6-TG) for pediatric acute lymphoblastic leukemia (ALL) is associated with high rates of hepatic sinusoidal obstruction syndrome (SOS). Nevertheless, current treatment continues to use short-term applications of 6-TG with only sparse information on toxicity. 6-TG is metabolized by thiopurine methyltransferase (TPMT) which underlies clinically relevant genetic polymorphism. We analyzed the association between hepatic SOS reported as a serious adverse event (SAE) and short-term 6-TG application in 3983 pediatric ALL patients treated on trial AIEOP-BFM ALL 2000 (derivation cohort) and defined the role of TPMT genotype in this relationship. We identified 17 patients (0.43%) with hepatic SOS, 13 of which with short-term exposure to 6-TG (P < 0.0001). Eight of the 13 patients were heterozygous for low-activity TPMT variants, resulting in a 22.4-fold (95% confidence interval 7.1–70.7; P ≤ 0.0001) increased risk of hepatic SOS for heterozygotes in comparison to TPMT wild-type patients. Results were supported by independent replication analysis. All patients with hepatic SOS after short-term 6-TG recovered and did not demonstrate residual symptoms. Thus, hepatic SOS is associated with short-term exposure to 6-TG during treatment of pediatric ALL and SOS risk is increased for patients with low-activity TPMT genotypes.

authors

  • Stanulla, Martin
  • Schaeffeler, Elke
  • Möricke, Anja
  • Buchmann, Swantje
  • Zimmermann, Martin
  • Igel, Svitlana
  • Schmiegelow, Kjeld
  • Flotho, Christian
  • Hartmann, Hans
  • Illsinger, Sabine
  • Sauerbrey, Axel
  • Junk, Stefanie V
  • Schütte, Peter
  • Hinze, Laura
  • Lauten, Melchior
  • Modlich, Simon
  • Kolb, Reinhard
  • Rossig, Claudia
  • Schwabe, Georg
  • Gnekow, Astrid K
  • Fleischhack, Gudrun
  • Schlegel, Paul Gerhard
  • Schunemann, Holger
  • Kratz, Christian P
  • Cario, Gunnar
  • Schrappe, Martin
  • Schwab, Matthias

publication date

  • March 13, 2021