A prospective cohort study on multidrug resistance associated P glycoprotein as a prognostic factor of complete remission in acute leukemia at diagnosis

Objective To determine whether multidrug resistance associated P glycoprotein (Pgp) is a prognostic factor for complete remission (CR) in acute leukemia (AL) patients at diagnosis. Methods Prospective,inception,cohort study of 48 new AL cases with age from 15 to 70 years old without history of chemotherapy.Diagnosis and CR criteria of AL were according to the French American British (FAB) group criteria.The Pgp were tested by flow cytometric analysis using monoclonal antibody UIC2.Exposed and unexposed groups were Pgp positive and negative AL cases.Logistic regression was used to analyze between the CR rate the Pgp. Results The numbers of Pgp negative( ) and positive (+) cases were 25 and 23.The CR rate in the two groups were 68% and 22%,respectively.After the univariate analysis, Pgp (group was easier to get CR than Pgp+group (RR=7.65,95%CI2.1～28, P =0.002).Age,sex,initial white blood cell count (WBC),bone marrow (BM) blast percentage and FAB subtypes were not significant to the CR rate.Multivariate analysis adjusted by above factors shows that the Pgp was also highly significant to the CR rate (RR=9.3,95%CI 2.2～39, P =0.002).The sensitivity was 69%,specificity 77%,positive predictive value 78%,negative predictive value 68%,positive likelihood ratio 3,negative likelihood ratio 0.4,prevalence 54%,accuracy 73% for Pgp diagnosing the primary resistant AL cases. Conclusion Pgp+is an unfavorable prognositc factor for complete remission in acute leukemia patients at diagnosis.We could use it to predict the primary resistant acute leukemia case.