Expression of genes related to multiple drug resistance and apoptosis in acute leukemia: response to induction chemotherapy

Resistance to chemotherapy is a major impediment to the successful treatment of acute leukemia (AL). Expression of genes involved in drug resistance and apoptosis may be responsible for this. This study aimed to investigate the expression of drug resistance (MDR1, MRP1, LRP, BCRP, GSTP1, DHFR) and apoptotic genes (p53, BCL-2, Survivin) in adult acute leukemias and compare them with clinical and hematological findings and response to induction chemotherapy. Eighty-five patients with AL [45 with acute myeloid leukemia (AML) and 40 with acute lymphoblastic leukemia (ALL)] were used as a study group. Real-time PCR results showed that expression level of MDR1 was significantly higher in AML whereas expression of DHFR, BCRP and Survivin was significantly higher in ALL patients. In AML, significant correlation was observed between LRP and MRP1 (rs = 0.44, p = 0.016), LRP and DHFR (rs = 0.41, p = 0.02), MDR1 and BCL-2 (rs = 0.38, p = 0.03). Expression of GSTP1 and LRP correlated with high white blood count (p = 0.03 and p = 0.03) and BCL-2 with high peripheral blast count (p = 0.009). MDR1 expression was significantly associated with the expression of immature stem cell marker CD34 (p = 0.002). In ALL, significant association was found between LRP gene and female sex (p < 0.0001), LRP and B-ALL patients (p = 0.04) and LRP and BCR/ABL positive patients (p = 0.004). High expression of MDR1 and BCL-2 in AML and MRP1 gene in ALL was associated with response to induction chemotherapy (p = 0.001, p = 0.02 and p = 0.007 respectively). These results showed the potential clinical relevance of MDR1, MRP1 and BCL-2 in adult patients with acute leukemia in the context of induction chemotherapy.

► Expression of drug resistance and apoptotic genes in acute leukemia by Real-time PCR.
► Significant higher expression of MDR1 in AML, DHFR, Survivin and p53 in ALL.
► MDR1 and BCL-2 in AML and MRP1 gene in ALL correlate with induction chemotherapy.
► Drug resistance and apoptotic genes may be responsible for induction failure in AL.