ABSTRACT:mRNA expression levels of certain genes have shown predictive value for the outcome of cytarabine-treated AML-patients. We hypothesized that genetic variants play a role in the regulation of the transcription of these genes. We studied leukoblasts from 82 patients with acute myeloid leukemia and observed various extent and frequency of differential allelic expression in the CDA, DCK, NT5C2, NT5C3, and TP53 genes. Our attempts to identify the causative regulatory single nucleotide polymorphisms by a bioinformatics approach did not succeed. However, our results indicate that genetic variations are at least in part responsible for the differences in overall expression levels of these genes.The deoxynucleoside analog cytarabine (1--D-arabinofuranosylcytosine) is a major component of the chemotherapeutic treatment of patients with acute myeloid leukemia (AML). The most important limitation for the use of deoxynucleoside analogs in the clinic is the presence of primary or acquired resistance. Several studies have identified clinically relevant mechanisms of resistance in patients with leukemia or other malignant diseases (Jordheim and Dumontet, 2007). In particular, the mRNA expression level of several genes has been correlated to the outcome of the treatment with cytarabine or gemcitabine (2Ј-2Ј-difluorodeoxycytidine), another analog of deoxycytidine. In all of these studies, large variations in the expression levels of genes involved in cytarabine metabolism have been observed between patients, suggesting the presence of important regulatory mechanisms. In addition to differences in levels and activities of transcription factors and stability of mRNA, variations in the genomic sequence of the gene and its regulatory elements can influence the mRNA level. In fact, at least 25 to 35% of interindividual differences in gene expression are supposed to be caused by cis-acting variations (Pastinen and Hudson, 2004).When a heterozygous genetic variation induces a difference in mRNA expression level, the two corresponding alleles are expressed at different levels. This is called differential allelic expression (DAE) or allelic expression imbalance (Pastinen and Hudson, 2004). Currently, DAE is studied in samples heterozygous for an exonic variation (exonic single nucleotide polymorphisms; cSNP) used as a marker to determine the relative amount of transcripts from the two alleles. This method allows the distinction between cis-and transacting effects because the cellular environment and mRNA extraction are exactly the same (Stamatoyannopoulos, 2004). The cSNP used for the assessment of DAE is not necessarily responsible for the allelic expression imbalance, and additional investigations are needed to identify the functional regulatory variant (regulatory SNP; rSNP) or the underlying epigenetic modification (Milani et al., 2007).Specific mRNA expression levels can be used to predict the outcome of cancer patients treated with chemotherapy. Because genetic variants are partially responsible for variations in gene expr...