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Year : 2019  |  Volume : 33  |  Issue : 1  |  Page : 69-70

TYMS gene polymorphism and treatment-related osteonecrosis in acute lymphoblastic leukemia

1 KMT Medical Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India; Department of Biological Science, Joseph Ayo Babalola University, Ikeji-Arakeji, Nigeria

Date of Web Publication14-Oct-2019

Correspondence Address:
Sora Yasri
KMT Medical Center, Bangkok
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jms.jms_95_18

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How to cite this article:
Yasri S, Wiwanitkit V. TYMS gene polymorphism and treatment-related osteonecrosis in acute lymphoblastic leukemia. J Med Soc 2019;33:69-70

How to cite this URL:
Yasri S, Wiwanitkit V. TYMS gene polymorphism and treatment-related osteonecrosis in acute lymphoblastic leukemia. J Med Soc [serial online] 2019 [cited 2022 Aug 7];33:69-70. Available from:


Acute lymphoblastic leukemia (ALL) is an important malignancy in pediatric oncology. The management of the disease usually required the aggressive oncology treatment. The great concern in the treatment of ALL is the complication. Skeletal morbidity in the children receiving chemotherapy becomes an important point for proper cancerous care.[1] Osteonecrosis is an important complication that usually requires proper management because the course of osteonecrosis complication in ALL patients is usually unpredictable.[2]

The effect of underlying gene polymorphism on the occurrence of osteonecrosis in ALL patients is very interesting. Recently, Mungmunpuntipantip and Wiwanitkit used nanostructure assessment to clarify two important polymorphisms, Fok1 polymorphism and CollA1 gene polymorphism, relating to osteonecrosis due to ALL treatment.[3] It was concluded that Fok1 polymorphism lacked a significant association with osteonecrosis risk due to the nature of loci depletion, which is different from Coll1A gene polymorphism which has single mutation.[3]

Here, the authors would like to report additionally on the nanostructure change in another important polymorphism. The focused polymorphism is TYMS polymorphism, which is widely mentioned for the association treatment-related osteonecrosis. ElHarouni et al. recently reported that there was no association between TYMS polymorphism and treatment-related osteonecrosis.[4] Based on the nanostructure assessment, the case of TYMS gene polymorphism is a tandem repeat gene variation. This is the same phenomenon as seen in depletion; the dysfunction of all genes can be seen. This is different from the case of single guanine (G) to thymidine (T) in CollA1 gene polymorphism. The molecular weight change in TYMS gene polymorphism is not seen and further not related to biological process that might lead to treatment-related osteonecrosis. This is different from the case of molecular weight change, increasing molecular weight, from 151.13 in G type to 242.22/mol in T type in case of Coll1 A gene polymorphism.[3] In fact, the alteration of molecular weight in single polymorphism that can further result in phenotypic change is seen in several medical disorders such as CTLA-4 A49G polymorphism that is associated with autoimmune blood disease.[5] Hence, it is no doubt that there might be no observed association between TYMS gene polymorphism and treatment-related osteonecrosis in ALL cases.

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There are no conflicts of interest.

  References Top

Mostoufi-Moab S, Ward LM. Skeletal morbidity in children and adolescents during and following cancer therapy. Horm Res Paediatr 2018;90:1-15.  Back to cited text no. 1
Krull K, Kunstreich M, Bronsema A, Bleckmann K, Classen CF, Erdlenbruch B, et al. Osteonecrosis in children with acute lymphoblastic leukemia at initial diagnosis and prior to any chemotherapy. Leuk Lymphoma 2019;60:78-84.  Back to cited text no. 2
Mungmunpuntipantip R, Wiwanitkit V. WITHDRAWN: Fok1 and col1A1 gene polymorphisms and development of treatment-related bone complications in children with acute lymphoblastic leukemia: Focus on molecular change Turk J Haematol 2018. [Epub ahead of print].  Back to cited text no. 3
ElHarouni D, Yassin D, Ali N, Gohar S, Zaky I, Adwan H, et al. Apharmacogenetic study of VDR fok1 and TYMS polymorphisms and their association with glucocorticoid-induced osteonecrosis in Egyptian children with acute lymphoblastic leukemia. Front Oncol 2018;8:541.  Back to cited text no. 4
Wiwanitkit V. CTLA-4 A49G polymorphism and autoimmune blood disease: A comment. Turk J Haematol 2011;28:247.  Back to cited text no. 5


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