title: Glutathione S-transferase M1 polymorphism: a risk factor for hepatic venoocclusive disease in bone marrow transplantation.
abstract: Hepatic venoocclusive disease (HVOD) in bone marrow transplantation (BMT) is attributed to toxicity of cytoreductive agents, especially busulfan and cyclophosphamide, in the conditioning therapy. Busulfan, as well as the metabolites of cyclophosphamide, are conjugated with glutathione (GSH), catalyzed by enzymes of the glutathione S-transferase (GST) family. To assess the impact of polymorphisms of the GST genes, GSTM1 and GSTT1, on the risk of HVOD, we evaluated 114 consecutive patients with beta-thalassemia major undergoing BMT. There was a significantly increased incidence of HVOD in patients with the GSTM1-null genotype compared with those with the GSTM1-positive genotype (46.5% vs 18.3%; P =.001). Pharmacokinetic analysis in these patients showed that the clearance of busulfan was higher and first-dose steady-state concentration was lower among those with HVOD (0.403 +/- 0.06 vs 0.33 +/- 0.071 L/h/kg, Student t test P value =.000 01; and 508 +/- 125 vs 656 +/- 255 ng/mL, t test P value =.001, respectively). We conclude that the GSTM1-null genotype predisposes to HVOD, and the sinusoidal endothelial cells and hepatocyte damage may be mediated by metabolites of busulfan through depletion of the cellular GSH pool.
authors.affiliation: Department of Haematology, Christian Medical College, Vellore 632 004, India. aloks@cmcvellore.ac.in
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
authors.forename: Balasubramanian
authors.initials: B
authors.lastname: Poonkuzhali
authors.forename: Ramachandran V
authors.initials: RV
authors.lastname: Shaji
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: Vikram
authors.initials: V
authors.lastname: Mathews
authors.forename: Mammen
authors.initials: M
authors.lastname: Chandy
authors.forename: Rajagopal
authors.initials: R
authors.lastname: Krishnamoorthy
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D005838:Genotype; D005982:Glutathione Transferase / Q000235:genetics*; D006504:Hepatic Veno-Occlusive Disease / Q000453:epidemiology / Q000235:genetics*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D011110:Polymorphism, Genetic; D012307:Risk Factors; D017086:beta-Thalassemia / Q000453:epidemiology / Q000235:genetics / Q000628:therapy*
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D005982:Glutathione Transferase; D002066:Busulfan