Ordering Recommendation

Predicts risk of dose-related toxicity to 5-FU therapy.

Mnemonic
DPYD
Methodology

Polymerase Chain Reaction/Fluorescence Monitoring

Performed

Mon, Thu

Reported

5-10 days

New York DOH Approval Status
This test is New York DOH approved.
Specimen Required
Patient Preparation
Collect

Lavender (EDTA), pink (K2EDTA), or yellow (ACD Solution A or B).

Specimen Preparation

Transport 3 mL whole blood. (Min: 1 mL)

Storage/Transport Temperature

Refrigerated.

Unacceptable Conditions

Plasma or serum. Heparinized specimens.

Remarks
Stability

Ambient: 72 hours; Refrigerated: 2 weeks; Frozen: 1 month.

Reference Interval
Interpretive Data

Background information for Dihydropyrimidine Dehydrogenase (DPYD), 3 Variants:
Characteristics:
 5-Fluorouracil (5-FU) is the most frequently used chemotherapeutic drug for the treatment of many types of cancer, particularly colorectal adenocarcinoma. Grade III-IV drug toxicity attributed to 5-FU occurs in approximately 16 percent of patients, and may include hematologic, gastrointestinal, and dermatologic complications. In some cases, this toxicity can cause death. When 5-FU is metabolized in the body, approximately 80 percent is catabolized by the dihydropyrimidine dehydrogenase (DPD) enzyme. Variants in the DPYD gene can lead to reduced 5-FU catabolism, resulting in the aforementioned toxicity complications.
Inheritance
: Autosomal codominant.
Cause
: DPYD gene mutations.
  DPYD Variants Tested:

      Non-functional alleles and toxicity risk:
       *13 (rs55886062, c.1679T>G) - Increased risk
       *2A (rs3918290, c.1905+1G>A) - Greatly increased risk
       c.2846A>T (rs67376798) - Increased risk
      A result of negative indicates no variants detected and is predictive of *1 functional alleles and normal enzymatic activity.
   Allele Frequency by Population:

       *13: Caucasian - 0.1 percent; Asian - absent; African American - absent
       *2A: Caucasian - 0.47-2.2 percent; Asian - absent; African American - absent
       c.2846A>T: Caucasians - 1.1 percent; Asian - absent; African American - absent
Clinical Sensitivity:
Estimated at 31 percent for the DPYD variants analyzed.
Methodology:
Polymerase chain reaction (PCR) and fluorescence monitoring.
Analytical Sensitivity and Specificity:
99 percent.
Limitations:
Only the targeted DPYD variants will be detected by this panel. Diagnostic errors can occur due to rare sequence variations. 5-FU drug metabolism, efficacy and risk for toxicity may be affected by genetic and non-genetic factors that are not evaluated by this test. Genotyping does not replace the need for therapeutic drug monitoring or clinical observation. 

Please note the information contained in this report does not contain medication recommendations, and should not be interpreted as recommending any specific medications. Any dosage adjustments or other changes to medications should be evaluated in consultation with a medical provider.

Compliance Statement C: For human genetic inheritable conditions and mutations. This test was developed and its performance characteristics determined by ARUP Laboratories. The U. S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.

Counseling and informed consent are recommended for genetic testing. Consent forms are available online.

Note
Hotline History
N/A
CPT Codes

81232

Components
Component Test Code* Component Chart Name LOINC
2012167 DPYD Specimen 31208-2
2013096 DPYD Genotype
2013097 DPYD Phenotype
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • 5FU drug toxicity
  • Capecitabine
  • Dihydropyrimidine
  • DPD
  • DPYD
  • DPYD genotyping
  • Fegafur
  • Uftoral
  • Xeloda
Dihydropyrimidine Dehydrogenase (DPYD), 3 Variants