title: Glutathione S-transferase A1 polymorphisms and acute graft-vs.-host disease in HLA-matched sibling allogeneic hematopoietic stem cell transplantation.
abstract: Busulfan and the metabolites of cyclophosphamide are conjugated with glutathione and catabolized by enzymes of the cytosolic glutathione S-transferases family. There are clearly linked single nucleotide polymorphisms in the promoter region of the glutathione S-transferase A1 gene (i.e., GSTA1*A, -567T, -69C and -52G; GSTA1*B, -567G, -69T and -52A). We assessed whether the clinical outcomes, including acute graft-vs.-host disease, of 61 patients with hematological malignancies, following HLA-matched sibling allogeneic stem cell transplantation using busulfan/cyclophosphamide conditioning are altered by glutathione S-transferase A1 genotypes. Globally, grade II-IV acute graft-vs.-host disease developed in 13 patients (21%). Grade II-IV acute graft-vs.-host disease developed in 15.2% of 46 patients with GSTA1*A/*A diplotype and in 40.0% of 15 patients with GSTA1*A/*B or GSTA1*B/*B diplotype (p = 0.04). Moreover, this relationship between GSTA1*A/*A diplotypes and lower incidence of acute graft-vs.-host disease was independent of the age, gender, stem cell source, and disease status. The incidences of acute skin graft-vs.-host disease were 7% (3/46) in patients with GSTA1*A/*A and 27% (4/15) in patients without GSTA1*A/*A (p = 0.009, univariate; p = 0.01, multivariate). Acute hepatic graft-vs.-host disease developed in 6 (13%) of 46 patients with the GSTA1*A/*A diplotype and in 4 (27%) of 15 patients without this diplotype (p = 0.09, univariate; p = 0.12, multivariate). Ten patients (16%) developed hepatic veno-occlusive disease. No significant difference was found in the incidence of hepatic veno-occlusive disease between patients with and without the GSTA1*A/*A diplotype (19.6% vs. 6.7%; p = 0.24). We conclude that the GSTA1*A/*A diplotype is an independent protective factor against acute graft-vs.-host disease, especially for skin graft-vs.-host disease, and probably for hepatic graft-vs.-host disease, in patients using busulfan/cyclophosphamide conditioning. The identification of glutathione S-transferase A1 genotypes prior to allogeneic stem cell transplantation could allow conditioning regimens and graft-vs.-host disease prophylaxis to be modified to improve outcome.
authors.affiliation: Department of Internal Medicine, Seoul National University, Seoul, Korea.
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
authors.forename: Bhumsuk
authors.initials: B
authors.lastname: Keam
authors.forename: Kyung-Hun
authors.initials: KH
authors.lastname: Lee
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Oh
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Ra
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.forename: Sung Sup
authors.initials: SS
authors.lastname: Park
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Kim
authors.forename: Seonyang
authors.initials: S
authors.lastname: Park
authors.forename: Yun-Chul
authors.initials: YC
authors.lastname: Hong
authors.forename: Byoung Kook
authors.initials: BK
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D005838:Genotype; D005982:Glutathione Transferase / Q000235:genetics*; D006086:Graft vs Host Disease / Q000235:genetics*; D018380:Hematopoietic Stem Cell Transplantation; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery; D007951:Leukemia, Myeloid / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide; D035781:Siblings; D019172:Transplantation Conditioning
chemical_list: C484555:GSTA1 protein, human; D005982:Glutathione Transferase