急性淋巴细胞白血病患儿MTHFR基因多态性与大剂量甲氨蝶呤毒副反应的关系

Relationship between the methylenetetrahydrofolate reductase gene polymorphism and adverse reactions of high-dose methotrexate in children with acute lymphocytic leukemia

目的探讨亚甲基四氢叶酸还原酶(MTHFR)基因单核苷酸多态性对急性淋巴细胞白血病(ALL)患儿使用大剂量甲氨蝶呤(HD-MTX)化疗后毒副反应的影响。方法应用RT-PCR-变性梯度凝胶电泳结合DNA测序技术,对52例ALL患儿MTHFR C677T、A1298C和G1793A基因型进行检测。按照国立癌症研究所常规毒性判定标准(NCI-CTC)对患儿HD-MTX化疗后的不良反应统一评价。结果 MTHFR 1298AC基因型患儿发生血小板减少的风险较AA型提高了13.7倍(OR=13.7,95%CI=1.18～159.36,P=0.036)。MTHFR C677T和G1793A各基因型发生各类HD-MTX化疗不良反应的差异无统计学意义(P>0.05)。结论 MTHFR A1298C多态性可能与ALL患儿HD-MTX化疗后的毒副反应相关。

Objective To study the association between methylenetetrahydrofolate reductase （MTHFR） gene polymorphisms and toxicities after high-dose methotrexate （HD-MTX） infusion in children with acute lymphocytic leukemia （ALL）. Methods MTHFR variants in 52 children with ALL were determined by reverse transcriptase-polymerase chain reaction-denaturing gradient gel electrophoresis and sequencing. Toxicities of children who received HD-MTX chemotherapy were evaluated according to the National Cancer Institute-Common Toxicity Criteria （NCI-CTC）. Results The children carrying MTHFR 1298AC had a higher risk of developing thrombocytopenia compared with the carriers of the 1298 AA genotype （OR = 13. 7, 95% CI = 1. 18 - 159. 36, P = 0. 036 ）. There was no significant difference in HD-MTX chemotherapy-related adverse effects between the patients with different MTI-IFR C677T or G1793A genotypes. Conclusions MTHFR A1298C polymorohism may associate with the toxicity of HD-MTX chemotherapy in children with ALL.