5′‐nucleotidase, cytosolic II genotype, and clinical outcome in patients with acute myeloid leukemia with intermediate‐risk cytogenetics

Abstract Acute myeloid leukemia (AML) is a complex disease, and its treatment needs to be adjusted to the risk, which is conferred by cytogenetics and molecular markers. Cytarabine is the main drug to treat AML, and it has been suggested that the genotype of cytarabine metabolizing enzymes may have a prognostic relevance in AML. Here we report the association between the 5′‐nucleotidase, cytosolic II (NT5C2) rs10883841, cytidine deaminase (CDA) rs2072671 and rs532545 genotypes and the clinical outcome of 477 intermediate‐risk cytogenetic AML patients receiving cytarabine‐based chemotherapy. Patients younger than 50 years old with the NT5C2 rs10883841 AA genotype had lower overall survival (OS) ( p : .003; HR 2.16, 95% CI 1.29–3.61) and lower disease‐free survival (DFS) ( p : .002; HR 2.45, 95% CI 1.41–4.27), associated to a higher relapse incidence ( p : .010; HR 2.23, 95% CI 1.21–4.12). Interestingly, subgroup analysis showed that the negative effect of the NT5C2 rs10883841 AA genotype was detected in all subgroups except in patients with nucleophosmin mutation without high ratio FLT‐3 internal tandem duplication. CDA polymorphisms were associated with the complete remission rate after induction chemotherapy, without influencing OS. Further studies are warranted to determine whether this pharmacogenomic approach may be helpful to individualize AML treatment.