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. 2013 Oct;163(2):205-13.
doi: 10.1111/bjh.12516. Epub 2013 Aug 8.

Genetic susceptibility to anthracycline-related congestive heart failure in survivors of haematopoietic cell transplantation

Saro H Armenian  1 , Yan Ding, George Mills, Canlan Sun, Kalyanasundaram Venkataraman, Florence Lennie Wong, Susan L Neuhausen, David Senitzer, Shirong Wang, Stephen J Forman, Smita Bhatia
Affiliations

Genetic susceptibility to anthracycline-related congestive heart failure in survivors of haematopoietic cell transplantation

Saro H Armenian et al. Br J Haematol. 2013 Oct.

Abstract

Haematopoietic cell transplantation (HCT) survivors are at increased risk for developing congestive heart failure (CHF), primarily due to pre-HCT exposure to anthracyclines. We examined the association between the development of CHF after HCT and polymorphisms in 16 candidate genes involved in anthracycline metabolism, iron homeostasis, anti-oxidant defence, and myocardial remodelling. A nested case-control study design was used. Cases (post-HCT CHF) were identified from 2950 patients who underwent HCT between 1988 and 2007 at City of Hope and had survived ≥1 year. This cohort formed the sampling frame for selecting controls (without CHF) matched on: age, race/ethnicity, cumulative anthracycline exposure, stem cell source (allogeneic, autologous), and length of follow-up. Seventy-seven cases with pre-HCT germline DNA and 178 controls were genotyped. Multivariate analysis revealed that the odds of CHF was higher in females [Odds Ratio (OR) = 2·9, P < 0·01], individuals with pre-HCT chest radiation (OR = 4·7, P = 0·05), hypertension (OR = 2·9, P = 0·01), and with variants of genes coding for the NAD(P)H-oxidase subunit RAC2 (rs13058338, 7508T→A; OR = 2·8, P < 0·01), HFE (rs1799945, 63C→G; OR = 2·5, P = 0·05) or the doxorubicin efflux transporter ABCC2 (rs8187710, 1515G→A; OR = 4·3, P < 0·01). A combined (clinical and genetic) CHF predictive model performed better [area under the curve (AUC), 0·79] than the genetic (AUC = 0·67) or the clinical (AUC = 0·69) models alone.

Keywords: anthracyclines; congestive heart failure; genetic susceptibility; haematopoietic cell transplantation; late effects.

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Figures

Figure I
Figure I. Receiver operating characteristic (ROC) curves
ROC curves of three different models. Clinical model includes female sex, pre-haematopoietic cell transplantation (HCT) chest irradiation and post-HCT hypertension. The single nucleotide polymorphism (SNP) model includes at-risk variants of RAC2, HFE and ABCC2. The SNP and Clinical model includes all six variables.
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