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ORIGINAL ARTICLE
Year : 2014  |  Volume : 39  |  Issue : 2  |  Page : 86-90

TPMT gene polymorphism detection by conventional PCR in pediatric acute lymphoblastic leukemia and its toxic effect


1 Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
2 Department of Pediatric, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Correspondence Address:
Rania S Swelem
Clinical Pathology Department, Faculty of Medicine, Alexandria University
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1067.139775

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Introduction The purine analog mercaptopurine is a key medication for the successful treatment of childhood acute lymphoblastic leukemia, particularly for the consolidation and continuation therapies. Thiopurine S-methyltransferase (TPMT) catalyzes the inactivation of mercaptopurine. TPMT single-nucleotide polymorphisms can prospectively identify patients at higher risk for mercaptopurine toxicity. Patients and methods The TPMT genotype was determined by in-house conventional PCR followed by digestion of the product with restriction enzymes, MwoI FastDigest and AccI FastDigest. The study was carried out on a total of 80 participants: 40 pediatric patients with standard risk B-cell acute lymphoblastic leukemia and 40 age-matched and sex-matched healthy controls. Mercaptopurine was given to the patients in consolidation phase with oral dose of 75 mg/m 2 daily for 4 weeks. Toxicity of the drug was assessed at the end of this phase by complete blood profile and liver function tests. Results In the patients group, 97.5% were of the wild-type homozygous TPMT*1/*1 genotype and 2.5% were of the heterozygous TPMT*1/*3A genotype. In the control group, we identified 90% with the TPMT*1/*1 genotype, 7.5% with the TPMT*1/*3A genotype, and 2.5% with the TPMT*1/*3C genotype. Among the wild-type *1/*1 genotype patients in the patient group, 32.5% of patients suffered from either hepatoxicity and/or myelosuppression. Conclusion The homozygous wild-type TPMT*1/*1 genotype was the most frequent genotype in both cases and controls. TPMT*1/*3A was the most prevalent mutant genotype in this study. Although some patients had wild-type allele genotyping, they developed signs of toxicity.


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