Single nucleotide polymorphisms (SNPs) in the multiple drug resistance protein 1 (MRP1) and P-glycoprotein 1 (MDR1) genes modulate their ability to mediate drug resistance. We therefore sought to retrospectively evaluate their influence on outcomes in relapsed and/or refractory myeloma patients treated with bortezomib or bortezomib with pegylated liposomal doxorubicin (PLD). The MRP1/R723Q polymorphism was found in five subjects among the 279 patient study population, all of whom received PLD∈+∈bortezomib. Its presence was associated with a longer time to progression (TTP; median 330 vs. 129 days; p∈=∈0.0008), progression-free survival (PFS; median 338 vs. 129 days; p∈=∈0.0006), and overall survival (p∈=∈0.0045). MDR1/3435(C∈>∈T), which was in Hardy-Weinberg equilibrium, showed a trend of association with PFS (p∈=∈0.0578), response rate (p∈=∈0.0782) and TTP (p∈=∈0.0923) in PLD∈+∈ bortezomib patients, though no correlation was found in the bortezomib arm. In a recessive genetic model, MDR1/3435 T was significantly associated with a better TTP (p∈=∈0.0405) and PFS (p∈=∈0.0186) in PLD∈+∈bortezomib patients. These findings suggest a potential role for MRP1 and MDR1 SNPs in modulating the long-term outcome of relapsed and/or refractory myeloma patients treated with PLD∈+∈bortezomib. Moreover, they support prospective studies to determine if such data could be used to tailor therapy to the genetic makeup of individual patients.

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Keywords Bortezomib, MDR1, MRP1, Multiple myeloma, Pegylated liposomal doxorubicin, SNP
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Journal Annals of Hematology
Buda, G, Ricci, D, Huang, C.C, Favis, R, Cohen, N, Zhuang, S.H, … Orlowski, R.Z. (2010). Polymorphisms in the multiple drug resistance protein 1 and in P-glycoprotein 1 are associated with time to event outcomes in patients with advanced multiple myeloma treated with bortezomib and pegylated liposomal doxorubicin. Annals of Hematology, 89(11), 1133–1140. doi:10.1007/s00277-010-0992-3