[Expression and clinical significance of resistance proteins in initial acute lymphatic leukemia (ALL) in childhood].

In a retrospective study the expression of the resistance proteins P-170 glycoprotein (P-170), glutathione S-transferase pi (GST-pi), thymidylate-synthase (TS), dihydrofolate reductase (DHFR) and metallothionein (MT) was investigated in 111 patients with newly diagnosed acute lymphoblastic leukemia (ALL) using the streptavidin-biotin-peroxidase complex method. The expression of the resistance proteins was found in following frequency: P-170 in 39 (35%), GST-pi in 54 (49%), TS in 46 (42%), DHFR in 21 (20%) and MT in 30 (33%) cases of the investigated patients. Patients with overexpression of P-170 or GST-pi had a significant lower probability of remaining in continuous first remission (P < 0.05 for P-170 and P < 0.01 for GST-pi). The expression of TS and DHFR had no prognostic significance on the probability of first remission. Patients with MT-overexpression showed only a tendency for a lower probability of continuous first remission. Coexpression of P-170 and GST-pi was observed in leukemias of 22 patients (21%) and 38 patients (37%) showed no evidence for the expression of both markers. Combining P-170 and GST-pi improved the prognostic value. The expression of the resistance proteins was independent of age, sex, FAB-type, immunological subtype and of the initial peripheral blast cell count. The multivariate analysis indicated that only the expression of P-170 was an independent unfavorable prognostic factor for children with initial ALL. The reason for this was an minor correlation of P-170 and GST-pi (P = 0.01).