Glutathione
S
-transferases (GSTs) detoxify
potentially mutagenic and toxic DNA-reactive electrophiles, including
metabolites of several chemotherapeutic agents, some of which are
suspected human carcinogens. Functional polymorphisms exist in at least
three genes that encode GSTs, including
GSTM1,
GSTT1,
and
GSTP1.
We hypothesize,
therefore, that polymorphisms in genes that encode GSTs alter
susceptibility to chemotherapy-induced carcinogenesis, specifically to
therapy-related acute myeloid leukemia (t-AML), a devastating
complication of long-term cancer survival. Elucidation of genetic
determinants may help to identify individuals at increased risk of
developing t-AML. To this end, we have examined 89 cases of t-AML, 420
cases of
de novo
AML, and 1,022 controls for
polymorphisms in
GSTM1,
GSTT1,
and
GSTP1
. Gene deletion of
GSTM1
or
GSTT1
was not specifically associated with
susceptibility to t-AML. Individuals with at least one
GSTP1
codon 105 Val allele were significantly
over-represented in t-AML cases compared with
de novo
AML cases [odds ratio (OR), 1.81; 95% confidence interval (CI),
1.11–2.94]. Moreover, relative to
de novo
AML, the
GSTP1
codon 105 Val allele occurred more often among
t-AML patients with prior exposure to chemotherapy (OR, 2.66; 95% CI,
1.39–5.09), particularly among those with prior exposure to known
GSTP1 substrates (OR, 4.34; 95% CI, 1.43–13.20), and not among those
t-AML patients with prior exposure to radiotherapy alone (OR,1.01; 95%
CI, 0.50–2.07). These data suggest that inheritance of at least one
Val allele at
GSTP1
codon 105 confers a significantly
increased risk of developing t-AML after cytotoxic chemotherapy, but
not after radiotherapy.