The Influence of Thiopurine Methyltransferase Activity on Toxicity After High-dose Methotrexate in Childhood Acute Lymphoblastic Leukemia

NCT ID: NCT01886651

Last Updated: 2013-06-26

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 411 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2011-07-31
• Study Completion Date: 2012-02-29

Brief Summary

The purpose of this study is to explore the impact of thiopurine methyltransferase (TPMT) activity on the risk of HDM-related bone marrow- and hepatotoxicity and treatment interruptions during maintenance therapy for children with ALL.

Hypothesis of the study: Patients with TPMT activity compatible with TPMT low activity polymorphisms have an increased risk of toxicity following high-dose methotrexate (HDM) compared to children with normal TPMT activity.

Detailed Description

High-dose methotrexate (HDM) given concurrently with oral 6-mercaptopurine (6MP) may be followed by myelotoxicity, which may necessitate treatment interruption and thus interfere with the efficacy of the treatment of childhood ALL. Several studies have indicated that MTX and 6MP act synergistically. It has previously been reported that the risk of significant bone-marrow suppression is increased if oral 6MP is coadministered with HDM during maintenance therapy and that reductions of the dose of concurrently given oral 6MP can reduce the risk of significant myelotoxicity following HDM. MTX may increase the bioavailability of 6MP through inhibition of xanthine oxidase, which catabolizes 6MP. In addition, MTX may through inhibition of de novo purine synthesis enhance the availability of 6-thioguanine nucleotides (6TGN) that primarily exert the cytotoxic effect of 6MP.

The enzyme TPMT competes with the formation of 6TGN, as it methylates 6MP and thus create relatively non-toxic metabolites. TPMT heterozygous patients with one wild type and one low-activity allele have a higher risk of myelosuppression and treatment interruption compared to patients with TPMT wild type. Furthermore, TPMT heterozygous patients have a reduced risk of relapse and a higher risk of secondary malignancy compared to patients with TPMT wild type.

Little has been published on the influence of both TPMT activity and 6MP dosage on myelo- and hepatotoxicity following HDM.

Conditions

Acute Lymphoblastic Leukemia

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Eligibility Criteria

Inclusion Criteria

• included in the NOPHO ALL92 protocol
• available TPMT phenotype
• treated at least once with HD-MTX 5.0 g/m2 (+- 10%) during maintenance therapy
• at least one available measurement on blood counts or alanine aminotransferase levels 28 days after HD-MTX

Exclusion Criteria

• HR ALL
• children with Down Syndrome
• Events during maintenance therapy
• TPMT deficiency

• Minimum Eligible Age: 1 Year
• Maximum Eligible Age: 15 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Nordic Society for Pediatric Hematology and Oncology

OTHER

Sponsor Role: collaborator

Rigshospitalet, Denmark

OTHER

Sponsor Role: lead

Responsible Party

Kjeld Schmiegelow

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Kjeld Schmiegelow, M.D.

Role: PRINCIPAL_INVESTIGATOR

Rigshospitalet, Denmark

Locations

Kjeld Schmiegelow

Copenhagen, , Denmark

Countries

Denmark

Other Identifiers

NOPHO ALL92 study HDM TPMT

Identifier Type: -

Identifier Source: org_study_id