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Blood, 1 May 2008, Vol. 111, No. 9, pp. 4496-4499.
Prepublished online as a Blood First Edition Paper on February 19, 2008; DOI 10.1182/blood-2007-11-123885.


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CLINICAL TRIALS AND OBSERVATIONS

Brief Report

A PAI-1 (SERPINE1) polymorphism predicts osteonecrosis in children with acute lymphoblastic leukemia: a report from the Children's Oncology Group

Deborah French1, Leo H. Hamilton1, Leonard A. Mattano, Jr2, Harland N. Sather3, Meenakshi Devidas3, James B. Nachman4, and Mary V. Relling1,5

1 Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN; 2 Pediatric Hematology/Oncology, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo; 3 Children's Oncology Group Operations Center, Arcadia, CA; 4 Department of Pediatric Hematology-Oncology, University of Chicago, IL; and 5 University of Tennessee, Memphis

As glucocorticoid use increased in acute lymphoblastic leukemia, osteonecrosis became an increasingly frequent complication. Besides increased age, host risk factors are poorly defined. We tested whether 12 polymorphisms were associated with osteonecrosis among patients 10 years and older treated on the CCG1882 protocol. Candidate genes (TYMS, MTHFR, ABCB1, BGLAP, ACP5, LRP5, ESR1, PAI-1, VDR, PTH, and PTHR) were chosen based on putative mechanisms underlying osteonecrosis risk. All children received dexamethasone, with doses varying by treatment arm. A PAI-1 polymorphism (rs6092) was associated with risk of osteonecrosis in univariate (P = .002; odds ratio = 2.79) and multivariate (P = .002; odds ratio = 2.89) analyses (adjusting for gender, age, and treatment arm). Overall, 21 of 78 (26.9%) children with PAI-1 GA/AA genotypes, versus 25 of 214 (11.7%) children with GG genotype, developed osteonecrosis. PAI-1 polymorphisms and PAI-1 serum levels have previously been associated with thrombosis. We conclude that PAI-1 genetic variation may contribute to risk of osteonecrosis.


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M. L. te Winkel, I. M. Appel, R. Pieters, and M. M. van den Heuvel-Eibrink
Impaired dexamethasone-related increase of anticoagulants is associated with the development of osteonecrosis in childhood acute lymphoblastic leukemia
Haematologica, October 1, 2008; 93(10): 1570 - 1574.
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