Distress and symptom development in relation to plasma cytokines and secretion of DAMPs during remission induction treatment for acute myeloid leukemia

Abstract

The objective of the study was to assess the relation between development of cancer- and cancer therapy-induced symptoms, distress, plasma levels of cytokines, and damage-associated molecular patterns (DAMPs) in patients with acute myeloid leukemia (AML; n = 45) receiving remission induction chemotherapy. Patients were monitored for somatic symptoms (MDASI-core) and distress. Blood samples were obtained prior to chemotherapy (baseline) and weekly during the first 3 weeks of therapy. Symptom severity and distress were high at baseline, decreased during therapy, and were related on all time-points (r’s = .45–71). High baseline distress was related to a stronger decrease in symptom severity during chemotherapy ( r = −.34).The pro-inflammatory cytokines IL-6, TNF-alpha, IL-7, and IL-15 increased and the DAMPs HMGB1 and HSP70 decreased during chemotherapy. Higher baseline symptom severity was related to larger increases in IL-7 ( r = .38). Higher baseline distress predicted less decrease in HMGB1 ( r = .32) and was correlated with plasma concentrations of HSP70 at all time-points ( r = .35–.42). In conclusion, most patients with AML suffer from severe somatic symptoms together with high distress prior to chemotherapy. Although chemotherapy was associated with increases in cytokine production, somatic symptom scores did not increase during therapy. High distress at baseline was related to higher levels of DAMPs during treatment, which are associated with poorer prognosis. These data suggest that it would be interesting to investigate the benefit of early stress reduction during diagnosis of AML.