PROGNOSTIC VALUE OF P-GLYCOPROTEIN EXPRESSION AND BCL-2/BAX RATIO IN AML PATIENTS

Multidrug resistance (MDR) has become a major cause of treatment failure in acute myeloid leukemia (AML) . P-glycoprotein (P-gp) has been reported to be an important predictor of treatment outcome. In addition, B-cell lymphoma-2 (bcl-2) is an anti-apoptotic protein that results in resistance to chemotherapeutic agents. The aim of this study was to analyze the value of P-gp expression, bcl-2 and bax ratio in bone marrow samples as a predictor of their prognostic value in patients with de novo AML Thirty patients were evaluated for P-gp expression, bax and bcl-2 by flow cytotnetry using specific manoclanal antibodies. The results were expressed as mean fluorescence intensity (MFI) and bax/bcl2 ratio obtained by dividing bax MFI and bcl-2 MFI . Only hyperleukocytosis was significantly associated with higher expression of P-gp. High expression of P-gp and low bax/bcl-2 ratio were associated with FAB subtypes MO-Mi and CD34+ cells. A significant high resistance to induction therapy was observed in patients with increased P-gp expression as well as in those with low bax/bcl2. in conclusion P-gp , bcl -2 and bax are sensitive indicators of the clinical outcome in patients with de novo AML. Therefore, their determination should be taken into consideration when designing therapeutic regimens with MDR modulators.