Original Article

Cancer Chemotherapy and Pharmacology

, Volume 69, Issue 3, pp 691-696

The role of MTHFR and RFC1 polymorphisms on toxicity and outcome of adult patients with hematological malignancies treated with high-dose methotrexate followed by leucovorin rescue

  • Patrizia ChiusoloAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore Email author 
  • , Sabrina GiammarcoAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
  • , Silvia BellesiAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
  • , Elisabetta MetafuniAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
  • , Nicola PiccirilloAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
  • , Daniela De RitisAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
  • , Sara MariettiAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
  • , Sorà FedericaAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
  • , Luca LaurentiAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
    • , Luana FianchiAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
    • , Stefan HohausAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
    • , Leone GiuseppeAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore
    • , Simona SicaAffiliated withDepartment of Hematology, Università Cattolica del Sacro Cuore

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Abstract

Purpose

In the last years, the influence of different genes involved in metabolism of chemotherapeutic agents has been studied. Methotrexate (MTX) is a key compound of chemotherapeutic regimens used in the treatment of acute lymphoblastic leukemia (ALL), primary central nervous system lymphoma (PCNSL) and Burkitt’s lymphomas (BL). This study aims to evaluate the role of MTHFR C677T and A1298C polymorphisms and G80A reduced folate carrier gene (RFC1) in a cohort of adult patients with lymphoproliferative malignancies submitted to high-dose MTX followed by leucovorin rescue.

Methods

We performed the analysis of these polymorphisms on genomic DNA with RFLP–PCR.

Results

Patients carrying MTHFR A1298C variant showed decreased hepatic and hematological toxicity (P = 0.03). Overall survival (OS) and progression-free survival (PFS) between homozygous wild-type and variant patients for the RFC1 G80A were significantly different (P = 0.035 and P = 0.02, respectively). A significant correlation between hematological toxicity and age (P = 0.003) was observed. There was no significant influence of MTHFR C677T genotype on toxicity, OS and PFS.

Conclusions

Leucovorin rescue given after high-dose MTX probably accounts for the lack of influence of C677T polymorphism. To better define a role of RFC1 polymorphism on patients outcome, it would be worthwhile to perform a study on intracellular MTX level and RFC1 substrate binding affinities in different genotypes.

Keywords

High-dose methotrexate MTHFR polymorphisms RFC1 polymorphisms Lymphoproliferative diseases Toxicity Outcome