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Altered immune and treatment response gene expression signatures among poverty-exposed children with B-ALL

Amy Guillaumet-Adkins1,2, Noori Sotudeh1,3, Sayalee Potdar1

  • 1Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.

Biorxiv : the Preprint Server for Biology
|February 9, 2026
PubMed

Insights

Children with cancer living in poverty have a higher risk of relapse. Poverty-exposed children with acute lymphoblastic leukemia (ALL) show early signs of steroid resistance and immune changes at diagnosis.

Area of Science:

  • Pediatric Oncology
  • Cancer Immunology
  • Socioeconomic Determinants of Health

Background:

  • Children with cancer often receive standardized treatments, yet socioeconomic factors significantly impact outcomes.
  • Children living in poverty face higher risks of cancer relapse and mortality compared to affluent peers.
  • Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, with poverty linked to increased early relapse rates.

Purpose of the Study:

  • To investigate the molecular and cellular differences in pediatric B-acute lymphoblastic leukemia (B-ALL) between children exposed to poverty and their affluent counterparts at diagnosis.
  • To identify potential mechanisms contributing to poorer outcomes in poverty-exposed children with B-ALL.

Main Methods:

  • Single-cell RNA sequencing was employed to analyze leukemic blasts and the tumor microenvironment.
  • Transcriptional signatures and immune cell profiles were compared between poverty-exposed and non-poverty-exposed pediatric B-ALL patients.

Main Results:

  • Poverty-exposed children with standard-risk B-ALL exhibited transcriptional signatures indicative of steroid resistance at diagnosis.
  • Increased inflammatory signatures were observed in myeloid cells, and reduced effector signatures in CD8+ T-cells of poverty-exposed B-ALL patients.
  • These findings suggest distinct biological profiles associated with poverty in pediatric B-ALL.

Conclusions:

  • Socioeconomic status influences the biological characteristics of pediatric B-ALL at diagnosis.
  • Identifying these poverty-associated molecular and immune alterations may reveal targets for novel therapeutic strategies.
  • Further research into these mechanisms could lead to risk-adapted treatments to improve outcomes for all children with ALL.

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