Glutathione Transferase Gene Variants Influence Busulfan Pharmacokinetics and Outcome After Myeloablative Conditioning
| Autor: | Yngvar Fløisand, Lorentz Brinch, Tobias Gedde-Dahl, Sara Bremer, Stein Bergan |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Transplantation Conditioning Adolescent Cyclophosphamide therapeutic drug monitoring medicine.medical_treatment Gene Dosage Hematopoietic stem cell transplantation Pharmacology Glutathione transferase Young Adult Pharmacokinetics glutathione transferase medicine Humans Pharmacology (medical) busulfan Gene Drug toxicity Alleles Aged Retrospective Studies pharmacogenetics business.industry Myeloablative conditioning Hematopoietic Stem Cell Transplantation Genetic Variation Middle Aged Treatment Outcome surgical procedures operative ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Female Original Article business Busulfan medicine.drug |
| Zdroj: | Therapeutic Drug Monitoring |
| ISSN: | 0163-4356 |
| Popis: | Supplemental Digital Content is Available in the Text. Background: Busulfan (Bu) and cyclophosphamide (Cy) are frequently included in conditioning regimens before hematopoietic stem cell transplantation (HSCT). Both drugs are detoxified by glutathione transferases (GST), and GST gene variants may explain some of the interindividual variability in pharmacokinetics and drug toxicity. Methods: The study investigated adult patients (n = 114) receiving oral Bu pre-HSCT. Bu doses were adjusted to obtain an average steady-state concentration (Css) of 900 mcg/L. Results: Median first dose Bu Css was 1000 mcg/L (600–1780 mcg/L). Patients carrying 1 and 2 GSTA1*B (rs3957357) alleles demonstrated median 12% and 16% higher Bu Css (P ≤ 0.05). Bu exposure (average Css; odds ratio = 1.009, 95% confidence interval = 1.002–1.017, P = 0.013) and GSTM1 gene copy number (odds ratio = 17.1, 95% confidence interval = 1.46–201, P = 0.024) were significant predictors of mortality ≤30 days. The mortality was 25% versus 2% among carriers of 2 versus no GSTM1 copies (P = 0.021). Mortality ≤3 months was associated with higher first dose Bu exposure (1090 versus 980 mcg/L, P = 0.021). GSTM1 expression and high Bu exposure may increase Cy toxicity by reducing intracellular glutathione. Conclusions: GST genotyping before HSCT may allow better prediction of Bu pharmacokinetics and drug toxicity, and thereby improve outcome after BuCy conditioning. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|