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Pharmacogenetics of Intravenous and Oral Busulfan in Hematopoietic Cell Transplant Recipients
Author(s) -
Abbasi Nissa,
Vadnais Barbara,
Knutson Jennifer A.,
Blough David K.,
Kelly Edward J.,
O'Donnell Paul V.,
Deeg H. Joachim,
Pawlikowski Matthew A.,
Ho Rodney J.Y.,
McCune Jeannine S.
Publication year - 2011
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1177/0091270010382915
Subject(s) - busulfan , medicine , dosing , pharmacology , population , hematopoietic stem cell transplantation , pharmacokinetics , pharmacogenetics , gastroenterology , oncology , transplantation , genotype , chemistry , biochemistry , environmental health , gene
Kinetics‐based dose targeting is often conducted in hematopoietic cell transplant (HCT) patients conditioned with intravenous (IV) or oral busulfan to lower rates of rejection, nonrelapse mortality, and relapse. Using the candidate gene approach, the authors evaluated whether busulfan clearance was associated with polymorphisms in the genes regulating the predominant metabolizing enzymes involved in busulfan conjugation, specifically glutathione S‐transferase (GST) isoenzymes A1 (GSTA1) and M1 (GSTM1). Busulfan clearance was estimated after the morning dose on days 1, 2, and 3; each patient's average clearance was used for analyses. The average (± standard deviation) busulfan clearance was 3.2 ± 0.56 mL/min/kg in the separate population of 95 patients who received oral busulfan and 103 ± 24 ml/min/m 2 in the 57 patients who received IV busulfan. Oral busulfan clearance was associated with GSTA1 ( P = .008) but not GSTM1 ( P = .57) genotypes. However, among the GSTA1 haplotypes (ie, * A * A , * A * B , * B * B ), there was significant overlap in the observed oral busulfan clearance and similar rates of achieving the target busulfan exposure. Clearance of IV busulfan was not associated with GSTA1 ( P = .21) or GSTM1 ( P = .99). These data suggest that personalizing either IV or oral busulfan dosing cannot be simplified on the basis of GSTA1 or GSTM1 genotype.