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Low Socioeconomic Status, Adverse Gene Expression Profiles, and Clinical Outcomes in Hematopoietic Stem Cell Transplant Recipients. Clin Cancer Res 2016 Jan 01;22(1):69-78 PMID: 26286914 PMCID: PMC4703514

Pubmed ID



PURPOSE: Low socioeconomic status (SES) is associated with adverse outcomes among unrelated donor hematopoietic stem cell transplant (HCT) recipients, but the biologic mechanisms contributing to this health disparity are poorly understood. Therefore, we examined whether social environment affects expression of a stress-related gene expression profile known as the conserved transcriptional response to adversity (CTRA), which involves upregulation of proinflammatory genes and downregulation of genes involved in type I IFN response and antibody synthesis.

EXPERIMENTAL DESIGN: We compared pretransplant leukocyte CTRA gene expression between a group of 78 high versus low SES recipients of unrelated donor HCT for acute myelogenous leukemia in first remission. Post hoc exploratory analyses also evaluated whether CTRA gene expression was associated with poor clinical outcomes.

RESULTS: Peripheral blood mononuclear cells collected pre-HCT from low SES individuals demonstrated significant CTRA upregulation compared with matched HCT recipients of high SES. Promoter-based bioinformatics implicated distinct patterns of transcription factor activity, including increased CREB signaling and decreased IRF and GR signaling. High expression of the CTRA gene profile was also associated with increased relapse risk and decreased leukemia-free survival.

CONCLUSIONS: Low SES is associated with increased expression of the CTRA gene profile, and CTRA gene expression is associated with adverse HCT clinical outcomes. These findings provide a biologic framework within which to understand how social environmental conditions may influence immune function and clinical outcomes in allogeneic HCT.

Author List

Knight JM, Rizzo JD, Logan BR, Wang T, Arevalo JM, Ma J, Cole SW


Jennifer M. Knight MD Assistant Professor in the Psychiatry department at Medical College of Wisconsin
Brent R. Logan PhD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
J. Douglas D. Rizzo MD, MS Director, Ctr Associate Director, Professor in the Medicine department at Medical College of Wisconsin
Tao Wang PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin


2-s2.0-84954345425   17 Citations

MESH terms used to index this publication - Major topics in bold

Cause of Death
Gene Expression Profiling
Hematopoietic Stem Cell Transplantation
Leukocytes, Mononuclear
Middle Aged
Patient Outcome Assessment
Risk Factors
Social Class
Tissue Donors
Young Adult
jenkins-FCD Prod-297 dff1a717c492f00bf6291286365f1f4fe95208f1