Severe Vincristine-Induced Neuropathic Pain: A Case Report with Pharmacogenetic Analysis and Literature Review

Figures & data

Figure 1 Chronology of Chemotherapy Medications and Adverse Effects.

Abbreviations: VCR, vincristine; MTX, methotrexate; Ara-c, cytarabine; DXM, dexamethasone; DNR, daunorubicin; PED, prednisone; PEG-ASP, PEG-aspargase; CPA, cyclophosphamide; 6MP, mercaptopurine; EPI, epirubicin; VDS, vindesine; qd, once a day; bid, twice a day; iv, intravenous injection; it, intrathecal injection; ivgtt, intravenous drip; po, oral adminstration; im, intramuscular injection.

Table 1 Patient’s Genotype Results Associated with VIPN and ALFA Allele Frequency

Gene	SNP	Risk Genotype	Patient’s Genotype	Interpretation	ALFA Allele Frequency*
CYP3A5	rs776746	GG (A>G)	GG	CYP3A5*3/*3 (CYP3A5 nonexpresser) ↑ risk and severity of VIPN	Caucasion: T/C=0.070032/0.929968
					African: T/C=0.69646/0.30354
					Asian: T/C=0.287/0.713
ABCC2	rs12826	GG	GG	↑ neurotoxicity	Caucasion: C/T=0.628557/0.371443
					African: C/T=0.8487/0.1513
					Asian: C/T=0.795/0.205
SYNE2	rs2781377	AA (G>A)	AA	↑ risk of VIPN	Caucasion: G/A=0.930333/0.069667
					African: G/A=0.8720/0.1280
					Asian: G/A=0.9032/0.0968
miR-4481	rs7896283	CC (T>C)	CC	↑ risk of VIPN	Caucasion: A/G=0.50419/0.49581
					African: A/G=0.6483/0.3517
					Asian: A/G=0.580/0.420
miR-3117	rs12402181	GG (G>A)	GA	Low-risk genotype	Caucasion: G/A=0.84586/0.15414
					African: G/A=0.6368/0.3632
					Asian: G/A=0.723/0.277
MTNR1B	rs12786200	TT (C>T)	CT	May ↑ the severity of VIPN	Caucasion: C/T=0.77462/0.22538
					African: C/T=0.7809/0.2191
					Asian: C/T=0.705/0.295
CEP72	rs924607	TT (C>T)	CT	Low-risk genotype	Caucasion: C/T=0.57101/0.42899
					African: C/T=0.8869/0.1131
					Asian: C/T=0.77/0.23
BAHD1	rs3803357	CC (C>A)	AA	↓ VIPN severity grade	Caucasion: C/A=0.502364/0.497636
					African: C/A=0.2455/0.7545
					Asian: C/A=0.1824/0.8176
NPSR1	rs887020	GG (A>G)	AG	↑ risk of abdominal pain in children	Caucasion: A/G=0.457305/0.542695
					African: A/G=0.8191/0.1809
					Asian: A/G=0.185/0.815

Note: *ALFA allele frequency data are from www.ncbi.nlm.nih.gov.