摘要：NUDT15 and
TPMT variants are strong genetic determinants of thiopurine-induced hematological toxicity. Despite the impact of homozygous
CRIM1 on thiopurine toxicity, several patients with wild-type
NUDT15, TPMT, and
CRIM1 experience thiopurine toxicity, therapeutic failure, and relapse of acute lymphoblastic leukemia (ALL). Novel pharmacogenetic interactions associated with thiopurine intolerance from hematological toxicities were investigated using whole-exome sequencing for last-cycle 6-mercaptopurine dose intensity percentages (DIP) tolerated by pediatric ALL patients (
N = 320).
IL6 rs13306435 carriers (
N = 19) exhibited significantly lower DIP (48.0 ± 27.3%) than non-carriers (
N = 209, 69.9 ± 29.0%;
p = 0.0016 and 0.0028 by
t test and multiple linear regression, respectively). Among 19 carriers, 7 with both heterozygous
IL6 rs13306435 and
CRIM1 rs3821169 showed significantly decreased DIP (24.7 ± 8.9%) than those with
IL6 (
N = 12, 61.6 ± 25.1%) or
CRIM1 (
N = 94, 68.1 ± 28.4%) variants.
IL6 and
CRIM1 variants showed marked inter-ethnic variability. Four-gene-interplay models revealed the best odds ratio (8.06) and potential population impact [relative risk (5.73), population attributable fraction (58%), number needed to treat (3.67), and number needed to genotype (12.50)
