Azacytidine, an antimetabolite with an original epigenetic mechanism of action, increases survival in patients diagnosed with high-risk myelodysplasic syndromes or acute myeloid leukemia with less than 30% medullar blasts. Azacytidine is a pyrimidine derivative that undergoes metabolic
detoxification driven by cytidine deaminase (CDA), a liver enzyme whose gene is prone to genetic polymorphism, leading to erratic activity among patients. Clinical reports have shown that patients with the poor metabolizer (PM) phenotype are likely to experience early severe or lethal toxicities
when treated with nucleosidic analogs such as gemcitabine or cytarabine. No clinical data have been available thus far on the relationships between CDA PM status and toxicities in azacytidine-treated patients. Here, we measured CDA activity in a case of severe toxicities with fatal outcome
in a patient undergoing standard azacytidine treatment. Results showed that the patient was PM (i.e. residual activity reduced by 63%), thus suggesting that an impaired detoxification step could have given rise to the lethal toxicities observed. This case report calls for further prospective
studies investigating the exact role that CDA status plays in the clinical outcome of patients treated with azacytidine.
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Document Type: Short Communication
SMARTc Unit, Pharmacokinetics Laboratory, UMR_911 CRO2 AMU, Pharmacy Unit
SMARTc Unit, Pharmacokinetics Laboratory, UMR_911 CRO2 AMU
Hematology Laboratory, La Conception University Hospital of Marseille
Transfer Oncology Laboratory, Nord University Hospital of Marseille, APHM, Marseille, France
Publication date: June 1, 2015