Variability Found in PROs, Gene Expression During AML Induction Chemo

Researchers pointed out that little data was previously available on gene expression and PROs in hematologic oncology compared to solid tumors.

Exploratory study data showed high levels of variability in patient-reported outcomes (PROs) as well as gene expression in the peripheral blood in patients with acute myeloid leukemia (AML) being treated with induction chemotherapy, according to findings presented at the 50th Annual Oncology Nursing Society Congress.¹

Patients included in the study (n = 10) were evaluated for coefficients of variation (CV) of peripheral whole blood gene expression on 31,665 genes. A gene enrichment analysis was conducted on genes with a CV greater than .07. Findings showed that patients had a median CV of gene expression of 0.48 (range, 0.19-0.92).

Additionally, the 5 genes to express the highest levels of variability included: FRMPD2, which is responsible for the management and establishment of cell polarization; AC073464; AC103808; ASCL1, which drives the development of neurons and autonomic neurons; and KCNK2, which is a potassium channel gene that regulates a cell’s uptake of potassium.

The PRO analysis showed that at baseline, the median PROMIS T scores were 48.6 (range, 36.3-60.3) for pain, 54.2 (range, 35.7-64.9) for sleep disturbance, 48.6 (range, 37.1-67.9) for depression, 52.3 (range, 37.1-79.9) for anxiety, 42.1 (range, 35.1-50.7) for global physical health, 54.7 (range, 35.5-63.6) for global mental health, and 51.1 (range, 42.2–56.0) for physical function.

“Symptom experience of patients with newly diagnosed AML can be highly individualized,” lead study author Joosun Shin, RN, PhD, and colleagues, wrote in a poster presentation of the data. “Larger, more diverse patient cohorts are warranted to deepen understanding of these variabilities and contributors in symptom experience.”

Shin is a postdoctoral research fellow at Dana-Farber Cancer Institute and a research fellow in medicine at Harvard University, both in Boston, Massachusetts.

In the poster, Shin and study authors noted that past research has delved into gene expression and symptom experience for patients with solid tumors; however, fewer data have been derived in the hematologic oncology space. Past studies have looked at gene expression profiling, which have helped derive risk-stratification and prognostic strategies in the AML space.²

In the exploratory study, which was conducted in junction with Dana-Farber Cancer Institute, the National Institutes of Health, and the National Institute of Nursing Research, investigators sought to assess the variabilities in PROs and correlative gene expression in the peripheral blood in patients with newly diagnosed AML who were admitted to the hospital to receive induction chemotherapy.¹ Investigators hypothesized that symptom experiences vary between individuals with AML who receive induction chemotherapy, and they suggested that using PROs and peripheral blood gene expression could enhance the understanding of these variabilities.

All 10 enrolled patients received inpatient induction chemotherapy, and the completed PROMIS symptom questionnaires at enrollment, then once per week through week 4 or discharge, whichever occurred earlier. PROs evaluated during the study included pain, sleep disturbance, depression, anxiety, global health, and physical function. Whole blood samples were also collected at baseline and again once per week through week 4 or hospital discharge, whichever was first.

The median age of enrolled patients was 69.5 years (range, 35-74). Sixty percent of patients were female, and all patients were White.

During the study, investigators also observed the enrichment of several biological processes, including modulation of chemical synaptic transmission, enriched molecular functions, and enriched cellular components. Enriched molecular function included processes such as monoatomic ion channel activity, and enriched cellular components comprised collagen-containing extracellular matrix and synaptic membrane, for example.

References

1. Shin J, Goto T, Heiling H, et al. Variability in gene expression and patient-reported outcome measures in patients undergoing induction chemotherapy for acute myeloid leukemia. Presented at: 50th Annual Oncology Nursing Society Congress; April 9-13, 2025; Denver, CO. Abstract RS119.
2. Wilson CS, Davidson GS, Martin SB, et al. Gene expression profiling of adult acute myeloid leukemia identifies novel biologic clusters for risk classification and outcome prediction. Blood. 2006;108(2):685-696. doi:10.1182/blood-2004-12-4633