Personalised chemotherapy for leukaemia patients a step closer

Researchers have determined how inherited gene variations lead to severe drug toxicity that may threaten chances for a cure in children with leukaemia, a finding which sets the stage to expand the use of a patient’s genetic make-up to tailor chemotherapy.

Thiopurines such as mercaptopurine are indispensable for curing acute lymphoblastic leukaemia (ALL), the most common childhood cancer.

Researchers from St Jude Children’s Research Hospital in US studied 270 children. They discovered four inherited variations in the NUDT15 gene that alter thiopurine metabolism and leave patients particularly sensitive to the drugs and at risk for treatment-disrupting toxicity. One in three Japanese patients in the study carried the high-risk variations. Evidence suggests that the variations are also common in other populations across Asia and those of Hispanic ethnicity, researchers said.

They demonstrated that the NUDT15 enzyme helps to balance thiopurine activity by reducing the supply of the active drug metabolite that triggers cell death.

This check-and-balance mechanism helps to prevent the excessive death of white blood cells that put patients at high risk for infections and other serious complications.