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High expression levels and the C3435T SNP of the ABCB1 gene are associated with lower survival in adult patients with acute myeloblastic leukemia in Mexico City



Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by different genetic alterations that cause changes in the normal mechanisms of differentiation, which are associated with chemoresistance. The ABCB1 gene is part of a family of ATP-binding cassette (ABC) transporter genes involved in the progression of various types of cancer. The following work aimed to evaluate the expression levels of the ABCB1 gene and the C3435T SNP with the response to first-line treatment and survival in patients with AML.


In total 135 samples were taken to isolate total RNA and DNA at the beginning of the treatment. Expression analysis by RT-qPCR and SNP C3435T assessment method were performed for real-time Polymerase chain reaction (qPCR).


The expression levels impact on the survival of patients with AML compared to low or absent levels; the CC genotype was found in 22.9%, the CT genotype was found in 47.4%, and the TT genotype was found in 29.6%, the presence of the C3435T SNP, the TT genotype also impacts with a lower survival compared to CT and CC genotypes. In addition, it was shown that the dominant model significantly impacts survival.


In conclusion, we have found that the overexpression of the ABCB1 gene, as well as the presence of the TT genotype of the C3435T SNP, contributes to a worse prognosis in AML.

Peer Review reports


Acute myeloid leukemia (AML) is the most frequent in adults, it is a myeloproliferative disorder with a high risk of relapse and a high mortality rate [1, 2]. In adult Mexican patients with AML, the median age is 32 years, less than other international series [3]. With the best treatment regimens (BMT, immunotherapy, and targeted molecular therapy), most patients with AML can achieve complete remission (CR) [4, 5]; however, 5-year survival in our country is only 25% of patients with AML [6, 7]. The molecular mechanisms that cause therapy failure leading to an unfavorable prognosis in AML are still not fully understood and are one of the most difficult obstacles in therapy [8].One of the common mechanisms for treatment failure is overexpression of drug resistance genes (MDR-1/ABCB1: ATP-binding cassette transporters) [9, 10]. The gene is located on chromosome 7q21.1 and is made up of 28 introns and 28 exons. ABCB1 mRNA is 4.7 kb, they encode a 170 kDa membrane transporter called P-glycoprotein (P-gp) [11, 12]. This gene has been studied extensively in search of polymorphisms; to date, around of 50 SNPs have been identified for ABCB1 [13]. The most studied polymorphisms are: C1236T (rs1128503), G2677T / A (rs2032582), and C3435T (rs1045642) [14, 15]. C3435T SNP is synonymous C to T polymorphism at nucleotide position 3435 in exon 26 (3435 C > T) [16]. This transition does not change the amino acid encoded with Ile at position 114,522; the TT variant has been associated with the decrease in the expression and with the stability of the protein as the transport of the drugs [17]. It has been described that the effect of the polymorphism can affect the post-transcriptional processing of mRNA by interfering with the intron removal process, as well as by affecting the process of alternative transcription splicing [18]. It has been reported that C3435T SNP and P-gp expression levels in AML patients could be associated with prognosis and the survival and relapse in AML patients [19]. Based on the above, we evaluated the frequency of the C3435T SNP, as well as the expression levels of the ABCB1 gene, associated with treatment response and survival in patients with AML.


Study population

In total, 135 patients with AML were analyzed at diagnosis, trials were taken into preservative-free heparin or into EDTA tubes following informed consent as approved by local and national ethics committees and sent laboratories in the Hospital General de Mexico, with a complete clinical record over a 4-year period (2016–2020). The sample size calculation was carried out through G-Power to obtain 80% of the effect size; we agree that the number of patients is low, but with the results obtained, the study can be expanded to include a more significant number of affected individuals.

The mean age was 47 years (15–92 years). Regarding gender, 48% were female (n = 65) and the rest male (n 70, 51.9%). The mean hemoglobin was 10.6 g/dl, (2.6–91 g/dl) with a mean Leukocyte of 154 × 109/ L (0.2–456 × 109/L) and 46 × 109/L for platelets (3–241 × 109/L). Regarding the main genetic alterations identified, 50.4% had a normal karyotype. The mean overall survival of the patients was 193 days (164–222), (Table 1). This study was approved by Ethics Committee of Hospital General de Mexico “Dr. Eduardo Liceaga”. Written informed consents to participate were obtained from all the participants in this study (written informed consent to participate of individuals younger than the age of 16 were obtained from their parents or legal guardians).

Table 1 Clinical characteristics of the population analyzed n = 135

Type of treatment

The treatment was based on the 7 + 3 scheme, the intensity of the treatment was mainly based on the age and functional status of the patients. The 7 + 3 normal intensity scheme (cytarabine 100 m /m2 for 7 days plus daunorubicin 60 mg/m2 for 3 days) was started in 108 patients (n = 80%), a total of 16 patients received reduced 7 + 3 doses (11.9%) and 7 patients received subcutaneous cytarabine (6.9%).

Response to treatment

The response to treatment was assessed considering the recovery of the hematic biometry parameters, the treatment was checked at day 28 based on bone marrow uptake. Complete Remission was defined as the patient having less than 5% of blasts at the end of induction therapy, Refractory patients remained leukemic, and Therapeutic Failure was defined as the patient dying during therapy. Patients who had complete remission and who presented an increase in the number of blasts (> 5%) at any time were considered to be in Relapse. The consolidation phase consisted of the administration of sequential blocks of chemotherapy, including administration of high doses of methotrexate. At the end of the study, the patients started the maintenance phase by administering weekly mercaptopurine and methotrexate for a duration of 2 years. In case of relapse to bone marrow, the patients received rescue therapy [20]. The evaluation of the minimal residual disease was evaluated at the hematological level. A total of 55 patients (40.7%) had Complete Remission criteria, while 16 patients (11.9%) were considered as Partial Response. Regarding refractory leukemia, 20.7% (n = 28) showed resistance to the first treatment scheme, while 26.6% (n = 36) died during the remission induction stage, 30 cases due to aplasia and 6 cases by indeterminate death.

Detection of SNP C3435T

Determination of single nucleotide polymorphisms (SNPs) was analyzed using real-time

Polymerase chain reaction (qPCR) by 48-well plate Step One Real Time PCR system (Applied Biosystems, Carlsbad, CA, USA) with TaqMan probes by Applied Biosystems Step One™. The SNP probes 3435C > T (rs1045642), of the ABCB1 gene. Master mixes were prepared as recommended by the manufacturer. 10 ng of DNA samples were added to each well and the reaction was carried out in a Step one Detection System (Life Technologies). The PCR conditions comprised an initial denaturation step of 10 min at 95 °C, followed by 5 cycles of 15 s denaturation at 95 °C, and one minute extension at 58 °C. This was followed by 40 cycles of 15 s denaturation at 95 °C and one minute extension at 60 °C. Real time data were collected during the last 40 cycles of amplification. They were evaluated for the dominant genetic model (CT + TT vs. CC) and the recessive genetic model (TT vs. CC + CT) [22]. The cell line k562, which presents the allele TT and cell line Molt4 with CT allele and the Jurkat cell line for CC of SNP C3435, were used as positive control.

Determination of the ABCB1 gene

All samples were collected from the bone marrow, and the mononuclear density (1.077 g/L). The mononuclear cell phase was separated and suspended in PBS medium and stored at − 70 °C. RNA Isolation was performed using TRIzol® (Invitrogen/Life Technologies). The RNA was stored at − 80 °C until needed. For cDNA synthesis, 2 μg of RNA final volume of 20μL was combined with 200U of the MMLV RT enzyme (Invitrogen, Carlsbad, CA, USA) [21].

Real-time polymerase chain reaction

The mRNA expression levels of the ABCB1 (Hs01069047) and glyceraldehyde 3-phosphate dehydrogenase (GAPDH; Hs00985689) genes were measured using TaqMan® gene expression assays (Applied Biosystems. Foster City, CA, USA). The GAPDH gene was used as an endogenous control, and each sample was analyzed in triplicate. The relative expression levels were calculated using the2 − ΔΔCt method. The high and low expression cutoff points were determined based on the mean values observed in 100 healthy donors. The RT-PCR conditions comprised an initial denaturation step of 10 min at 95 °C, followed by 60 °C 30″, 95 °C 10′; 30 cycling 95 °C 15′, 60 °C 1′ [22].

Statistical analysis

The multivariate analysis was performed based on clinical parameters, in the presence of C3435T SNP. A Kaplan Meier and Long Rank analysis was performed to assess survival in relation to each SNP, differences with p < 0.05 were considered significant by means of the SPSS Software, Version 20.0 (Statistical Package for Social Sciences, SPSS Inc, Chicago ILL, USA).


The relative expression levels of the ABCB1 gene were analyzed in 135 patients and 99 healthy donors. The results showed high expression, with a sixfold difference in ABCB1 (p = 0.001) from the group of healthy donors. The frequencies of patients with AML with high expression levels of the ABCB1 gene were 34.8% (47/135) Mean ± SD (range) 0.97 ± 15(0.65–1.9) median (0.94) and 37.7% (51/135) Mean ± SD (range) 0.48 ± 15(0.23–0.6) medians (0.45) presented low levels. No association was found between the clinical parameters and the ABCB1 gene expression levels and SNP C3435T (Tables 2, 3).

Table 2 Significance of the expression gene ABCB1
Table 3 Significance of the SNP ABCB1 C3435T gene

We demonstrated that at an overall survival (OS) of 400 days, low expression had OS values of 82% (42/51) with a mean of 265.4 days (204.9–325.9), while high-expression and negative patients had a lower survival with 36.2% (17/47) mean of 152.9 days (117.8–187.98), and 54% (20/37), with a mean of 157.2 (122.9–191.4) respectively. The results indicated a significant decrease in OS in patients with high expression levels of the ABCB1 gene log rank p = 0.002, (Fig. 1).

Fig. 1
figure 1

Significant decrease in OS in patients with high expression levels of the ABCB1 gene log rank p = 0.002

When analyzing the most frequent polymorphism of the C3435T SNP of the ABCB1 gene in patients with AML, the CC genotype was found in 22.9%, the CT genotype was found in 47.4%, and the TT genotype was found in 29.6%.

When analyzing OS with the presence of C3435T SNP, the mean survival time was shorter in patients with a TT genotype of 120 days (102.4–137.5) compared to the CC genotype of 220 days (170.8–271), and CT of 177 (131.53–222.56) log-rank (p = 0.034) (Fig. 2).

Fig. 2
figure 2

Significant decrease in OS in patients the presence of C3435T SNP

In the recessive and dominant models of SNP C3435T, the recessive TT was found to have an OS of 153 days (115–191) compared to CT + CC of 191 days (164–218), log rank (p = 0.021). In the case of the dominant model, the TC + TT combination was 183 days (153.2–214.2) versus CC 207 days (155–260), log-rank (p = 0.213), Fig. 3. When evaluating the risk of treatment failure, only age older than 60 and unfavorable cytogenetic prognosis were significant (OR 6.68; 95% CI: 2.56–17.36) and (OR 3.11; 95% CI: 1.49–6.46) respectively. Regarding the risk of death, the high levels of expression of the ABCB1 gene (OR 4.2; 95% CI: 1.98–8.91) and the TT genotype (OR 2.7; 95% CI: 1.28–5.81) presented statistical significance (Figs. 4 and 5).

Fig. 3
figure 3

Significant in OS in patients with the presence of the recessive and dominant models of SNP C3435T

Fig. 4
figure 4

Evaluating the risk of treatment failure. OR Odds Ratio, UCL Upper Confidence Limit (límite superior de confianza), LCL Lower Confidence Limit (límite inferior de confianza)

Fig. 5
figure 5

Evaluating the risk of Death. OR Odds Ratio. UCL Upper Confidence Limit (límite superior de confianza), LCL Lower Confidence Limit (límite inferior de confianza)


Resistance to treatment remains a major obstacle in AML, especially in young patients who represent a population with curative potential and long-term remission after intensive treatment; however, 30% of these patients with AML survive to 5 years with the best treatment schemes [23]. One of the mechanisms of resistance to treatment reported is the overexpression of drug resistance genes, causing unfavorable results and death [24, 25]. Overexpression of the gene and function of the glycoprotein (P-gp) can be altered by the presence of polymorphisms. The SNP 3435C > T (rs1045642) in exon 26, alters gene expression, protein activity, and substrate specificity [24]. Therefore, in this work, we examined whether the expression levels of the ABCB1 gene is affected due to the presence of C3435T SNP and its relationship with the prognosis and overall survival in adult AML patients [26, 27].

It was found that only 36% of the population had high levels of expression relative, 0.94 medians, range (0.65–1.9) of the ABCB1 gene, in patients with AML; several previous AML studies have shown that ABCB1 high level are expressed from 35 to 70% in adult cases [28, 29]. Regarding the high levels of expression and OS, a significant association was found; this is similar to that described by Boyer et al. 2019, where they showed that in a cohort of 161 patients with AML, a low level expression, 0.45 medians, range (0.23–0.6) of the ABCB1 gene a had higher OS [30]. In this hematological neoplasm, it has been reported that the rate of complete remission and drug resistance are related to the function and expression of ABCB1 [25]. It has been described that the expression and functional activity of the ABCB1 gene increases with the age of the patient, from the 17% in patients under 35 years of age up to 39% in patients 50 years of age or older [13]. In our population, the average age was 32 years, with a higher frequency of expression than that reported internationally, and this could have repercussions with the observed OS.

The frequency of the C3435T SNP of the ABCB1 gene population was 77% for the CC genotype, while the TT genotype was 40% in our study. These results are similar to those reported by other authors in AML and ALL [31, 32]. Regarding the association with clinical parameters, it has been reported that there is no association in the recessive and dominant models, which is in agreement with our findings. However, in solid cancer, the association with clinical parameters is different from that reported by Tazzite A, et al. where they found a significant correlation between the ABCB1 C3435T polymorphism and the clinical grades of breast cancer [33].

The possibility that other polymorphisms combine with the C3435T SNP to induce an effect on ABCB1 levels could be one of the reasons for this controversy. Several studies have shown a decrease with the expression of the ABCB1 gene and the presence of CT in patients with AML. [34, 35]. On the contrary, there are other studies that relate the TT or CC polymorphism with a lower expression of the ABCB1 gene [36]. Other authors mention that the expression of ABCB1 in patients with AML is independent of the presence of the C3435T genotype [31]. Our results showed that there is no association between the expression levels of the ABCB1 gene and the presence of the C3435T SNP, so it seems to be an independent mechanism. The increase in expression levels may be due to the fact that chemotherapeutic agents by themselves induce an increase in the expression of transporter genes or an increase in transcription activity, and not necessarily because of the presence of some of the TT genotypes or CT of C34345T SNP. Another explanation is that the C3435T SNP is out of balance with other non-coding polymorphisms, such as G2677T and C1236T, which are part of a common haplotype [35].

This SNP has been reported to play an important role in the efflux membrane pump of the P-glycoprotein, protecting cells and organs against xenobiotic agents and environmental carcinogens [37]. Therefore, the presence of the TT polymorphism affects transportation and the different types of treatments used in this neoplasm. In this study, we found that the TT genotype of C3435T SNP was associated with a lower OS. Thomas I. et., 2002 reported in 405 patients with AML that the CC genotype was associated with a lower OS [38]; however, other studies, such as that of Holt B. and that of Jamroziak K. et al., reported that the TT genotype of C3435T SNP does not significantly affect the clinical prognosis of patients with AML [39, 40]. These differences in the reports may be due to nutritional factors, sample size, methodology used and the type of ethnicity.

When evaluating the OR in our patients, a 4.2 times higher risk of death was demonstrated when ABCB1 levels are high and 2.7 times when the TT genotype is found. Various studies have shown that not all SNPs are considered silent; they can cause changes in the expression, conformation, or function of proteins and are increasingly implicated in the risk of human diseases [41].

Allele frequencies of the ABCB1 gene, C3435T polymorphism have been evaluated around the world, and significant inter-population differences have been detected (Leal-Ugarte et al. 2008) [42, 43]. According to the literature, the frequency of the T allele in Caucasian and Asian populations is about 50% for each [44].


We have proved that the overexpression of the ABCB1 gene, as well as the presence of the TT genotype of the C3435T SNP, adds to the outcome markers already known as FLT3, IDH, DNTM3, contributing to a worse prognosis. Therefore, detecting the levels and C3435T SNP in our population of patients with AML at diagnosis can help predict prognosis.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.



Acute myeloid leukemia


ATP-binding cassette B1


Real-time Polymerase chain reaction


Targeted molecular therapy


Achieve complete remission




Single nucleotide polymorphisms


Overall survival


  1. Pulte D, Redaniel MT, Jansen L, Brenner H, Jeffreys M. Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups. Haematologica. 2013;98(2):222–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Thein MS, Ershler WB, Jemal A, Yates JW, Baer MR. Outcome of older patients with acute myeloid leukemia: an analysis of SEER data over 3 decades. Cancer. 2013;119(15):2720–7.

    Article  PubMed  Google Scholar 

  3. Villela L, Bolaños-Meade J. Acute myeloid leukaemia: optimal management and recent developments. Drugs. 2011;71(12):1537–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lagunas-Rangel FA, Chávez-Valencia V, Gómez-Guijosa MÁ, Cortes-Penagos C. Acute myeloid leukemia-genetic alterations and their clinical prognosis. Int J Hematol Oncol Stem Cell Res. 2017;11(4):328–39.

    PubMed  PubMed Central  Google Scholar 

  5. Ostronoff F, Othus M, Ho PA, Kutny M, Geraghty DE, Petersdorf SH, Godwin JE, Willman CL, Radich JP, Appelbaum FR, Stirewalt DL, Meshinchi S. Mutations in the DNMT3A exon 23 independently predict poor outcome in older patients with acute myeloid leukemia: a SWOG report. Leukemia. 2013;27(1):238–41.

    Article  PubMed  Google Scholar 

  6. Sekeres MA, Guyatt G, Abel G, Alibhai S, Altman JK, Buckstein R. American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults. Blood Adv. 2020;4(15):3528–49.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hou HA, Tien HF. Genomic landscape in acute myeloid leukemia and its implications in risk classification and targeted therapies. J Biomed Sci. 2020;27(1):81.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Daver N, Cortes J, Kantarjian H, Ravandi F. Acute myeloid leukemia: advancing clinical trials and promising therapeutics. Expert Rev Hematol. 2016;9(5):433–45.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Christie EL, Pattnaik S, Beach J, Copeland A, Rashoo N, Fereday S. Multiple ABCB1 transcriptional fusions in drug resistant high-grade serous ovarian and breast cancer. Nat Commun. 2019;10(1):1295.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang H, Li JM, Wei W, Yang R, Chen D, Ma XD, Jiang GM, Wang BL. Regulation of ATP-binding cassette subfamily B member 1 by Snail contributes to chemoresistance in colorectal cancer. Cancer Sci. 2020;111(1):84–97.

    Article  PubMed  Google Scholar 

  11. Ankathil R. ABCB1 genetic variants in leukemias: current insights into treatment outcomes. Pharmgenom Pers Med. 2017;10:169–81.

    Google Scholar 

  12. Robey RW, Pluchino KM, Hall MD, Fojo AT, Bates SE, Gottesman MM. Revisiting the role of ABC transporters in multidrug-resistant cancer. Nat Rev Cancer. 2018;18(7):452–64.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tazzite A, Kassogue Y, Diakité B, Jouhadi H, Dehbi H, Benider A, Nadifi S. Association between ABCB1 C3435T polymorphism and breast cancer risk: a Moroccan case-control study and meta-analysis. BMC Genet. 2016;17(1):126.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jaramillo-Rangel G, Ortega-Martínez M, Cerda-Flores RM, Barrera-Saldaña HA. C3435T polymorphism in the MDR1 gene and breast cancer risk in northeastern Mexico. Int J Clin Exp Pathol. 2018;11(2):904–9.

    PubMed  PubMed Central  Google Scholar 

  15. Jin SS, Song WJ. Association between MDR1 C3435T polymorphism and colorectal cancer risk: a meta-analysis. Medicine (Baltimore). 2017;96(51):9428.

    Article  Google Scholar 

  16. Chowbay B, Li H, David M, Cheung YB, Lee EJ. Meta-analysis of the influence of MDR1 C3435T polymorphism on digoxin pharmacokinetics and MDR1 gene expression. Br J Clin Pharmacol. 2005;60(2):159–71.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Xiaohui S, Aiguo L, Xiaolin G, Ying L, Hongxing Z, Yilei Z. Effect of ABCB1 polymorphism on the clinical outcome of osteosarcoma patients after receiving chemotherapy. Pak J Med Sci. 2014;30(4):886–90.

    PubMed  PubMed Central  Google Scholar 

  18. Ma L, Ruan L, Liu H, Yang H, Feng Y. ABCB1 C3435T polymorphism is associated with leukemia susceptibility: evidence from a meta-analysis. Onco Targets Ther. 2015;5(8):1009–15.

    Google Scholar 

  19. Rafiee R, Chauhan L, Alonzo TA, Wang YC, Elmasry A, Loken MR. ABCB1 SNP predicts outcome in patients with acute myeloid leukemia treated with Gemtuzumab ozogamicin: a report from Children’s Oncology Group AAML0531 Trial. Blood Cancer J. 2019;9(6):51.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Olarte I, García A, Ramos C, Arratia B, Centeno F, Paredes J. Detection of mutations in the isocitrate dehydrogenase genes (IDH1/IDH2) using castPCRTM in patients with AML and their clinical impact in Mexico City. Onco Targets Ther. 2019;1(12):8023–31.

    Article  Google Scholar 

  21. Ramos-Peñafiel C, Olarte-Carrillo I, De la Cruz RA, Collazo-Jaloma J, Martínez-Tovar A. Association of three factors (ABCB1 gene expression, steroid response, early response at day + 8) on the response to induction in patients with acute lymphoblastic leukemia. Ann Hematol. 2020;99(11):2629–37.

    Article  PubMed  Google Scholar 

  22. Olarte Carrillo I, Ramos Peñafiel C, Miranda Peralta E, Rozen Fuller E, KassackIpiña JJ. Clinical significance of the ABCB1 and ABCG2 gene expression levels in acute lymphoblastic leukemia. Hematology. 2017;22(5):286–91.

    Article  PubMed  Google Scholar 

  23. Hirsch P, Tang R, Marzac C, Perrot JY, Fava F, Bernard C, Jeziorowska D, Marie JP, Legrand O. Prognostic impact of high ABC transporter activity in 111 adult acute myeloid leukemia patients with normal cytogenetics when compared to FLT3, NPM1, CEBPA and BAALC. Haematologica. 2012;97(2):241–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hampras SS, Sucheston L, Weiss J, Baer MR, Zirpoli G, Singh PK. Genetic polymorphisms of ATP-binding cassette (ABC) proteins, overall survival and drug toxicity in patients with acute myeloid leukemia. Int J Mol Epidemiol Genet. 2010;1(3):201–7.

    PubMed  PubMed Central  Google Scholar 

  25. Ankathil R. ABCB1 genetic variants in leukemias: current insights into treatment outcomes. Pharmgenom Pers Med. 2017;12(10):169–81.

    Google Scholar 

  26. Wang L-H, Song Y-B, Zheng W-L, Jiang L, Ma W-L. The association between polymorphisms in the MDR1 gene and risk of cancer: a systematic review and pooled analysis of 52 casecontrol studies. Cancer Cell Int. 2013;13:46.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Marzac C, Garrido E, Tang R, Fava F, Hirsch P, De Benedictis C. ATP Binding Cassette transporters associated with chemoresistance: transcriptional profiling in extreme cohorts and their prognostic impact in a cohort of 281 acute myeloid leukemia patients. Haematologica. 2011;96(9):1293–301.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Schaich M, Soucek S, Thiede C, Ehninger G, Illmer T, SHG AML96 Study Group. MDR1 and MRP1 gene expression are independent predictors for treatment outcome in adult acute myeloid leukaemia. Br J Haematol. 2005;128(3):324–32.

    Article  PubMed  Google Scholar 

  29. Boyer T, Gonzales F, Barthélémy A, Marceau-Renaut A, Peyrouze P, Guihard S, Lepelley P. Clinical significance of ABCB1 in acute myeloid leukemia: a comprehensive study. Cancers (Basel). 2019;11(9):1323.

    Article  PubMed Central  Google Scholar 

  30. Leith CP, Kopecky KJ, Chen IM, Eijdems L, Slovak ML, McConnell TS, Head DR, Weick J, Grever MR, Appelbaum FR, Willman CL. Frequency and clinical significance of the expression of the multidrug resistance proteins MDR1/P-glycoprotein, MRP1, and LRP in acute myeloid leukemia: a Southwest Oncology Group Study. Blood. 1999;94(3):1086–99.

    PubMed  Google Scholar 

  31. Yee SW, Mefford JA, Singh N, Percival ME, Stecula A, Yang K, Witte JS. Impact of polymorphisms in drug pathway genes on disease-free survival in adults with acute myeloid leukemia. J Hum Genet. 2013;58(6):353–61.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Illmer T, Schuler US, Thiede C, Schwarz UI, Kim RB, Gotthard S. MDR1 gene polymorphisms affect therapy outcome in acute myeloid leukemia patients. Cancer Res. 2002;62(17):4955–62.

    PubMed  Google Scholar 

  33. Hoffmeyer S, Burk O, von Richter O, Arnold HP, Brockmöller J, Johne A. Functional polymorphisms of the human multidrug-resistance gene: multiple sequence variations and correlation of one allele with P-glycoprotein expression and activity in vivo. Proc Natl Acad Sci USA. 2000;97(7):3473–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ghafouri H, Ghaderi B, Amini S, Nikkhoo B, Abdi M, Hoseini A. Association of ABCB1 and ABCG2 single nucleotide polymorphisms with clinical findings and response to chemotherapy treatments in Kurdish patients with breast cancer. Tumour Biol. 2016;37(6):7901–6.

    Article  PubMed  Google Scholar 

  35. Pan Y, Chen W, Wang Y, Li H, Johnston SC, Simon T, Zhao X, Liu L, Wang D, Meng X, Wang Y, Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) Investigators. Association between ABCB1 polymorphisms and outcomes of clopidogrel treatment in patients with minor stroke or transient ischemic attack: secondary analysis of a randomized clinical trial. JAMA Neurol. 2019;76(5):552–60.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kimchi-Sarfaty C, Oh JM, Kim IW, Sauna ZE, Calcagno AM, Ambudkar SV, Gottesman MM. A “silent” polymorphism in the MDR1 gene changes substrate specificity. Science. 2007;315(5811):525–8.

    Article  PubMed  Google Scholar 

  37. Jamroziak K, Młynarski W, Balcerczak E, Mistygacz M, Trelinska J, Mirowski M. Functional C3435T polymorphism of MDR1 gene: an impact on genetic susceptibility and clinical outcome of childhood acute lymphoblastic leukemia. Eur J Haematol. 2004;72(5):314–21.

    Article  PubMed  Google Scholar 

  38. Gervasini G, Carrillo JA, Garcia M, San Jose C, Cabanillas A, Benitez J. Adenosine triphosphate-binding cassette B1 (ABCB1) (multidrug resistance 1) G2677T/A gene polymorphism is associated with high risk of lung cancer. Cancer. 2006;107(12):2850–7.

    Article  PubMed  Google Scholar 

  39. Sauna ZE, Kimchi-Sarfaty C. Understanding the contribution of synonymous mutations to human disease. Nat Rev Genet. 2011;12(10):683–91.

    Article  PubMed  Google Scholar 

  40. Van der Holt B, Van den Heuvel-Eibrink MM, Van Schaik RH, van der Heiden IP. ABCB1 gene polymorphisms are not associated with treatment outcome in elderly acute myeloid leukemia patients. Clin Pharmacol Ther. 2006;80(5):427–39.

    Article  PubMed  Google Scholar 

  41. Jamroziak K, Balcerczak E, Cebula B, Janus A, Mirowski M, Robak T. No influence of 3435C>T ABCB1 (MDR1) gene polymorphism on risk of adult acute myeloid leukemia and P-glycoprotein expression in blast cells. Ther Drug Monit. 2006;28(5):707–11.

    Article  PubMed  Google Scholar 

  42. Van den Heuvel-Eibrink MM, Wiemer EA, de Boevere MJ, et al. MDR1expression in poor-risk acute myeloid leukemia with partial or complete monosomy 7. Leukemia. 2001;15:398–405.

    Article  PubMed  Google Scholar 

  43. Subhani S, Jamil K, Nirni SS. Association of MDR1 gene (C3435T) polymorphism and gene expression profiling in lung cancerpatients treated with platinum-based chemotherapy. Mol Diagn Ther. 2015;19:289–97.

    Article  PubMed  Google Scholar 

  44. Komoto C, et al. MDR1 haplotype frequencies in Japanese and Caucasian, and in Japanese patients with colorectal cancer and esophageal cancer. Drug Metab Pharmacokinet. 2006;21:126–32.

    Article  PubMed  Google Scholar 

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The authors thank Direccion de Investigacion Hospital General de Mexico.


This work was supported by the Direccion de Investigacion Hospital General Mexico “Dr. Eduardo Liceaga” (HGM/DI/08/204/04/1, DI/16/103/3/035, DI/19/103/03/006).

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IOC and AMT performed the analysis and drafted the manuscript. AGL carried out statistical analysis. and CORP contributed to patients recruitment and data acquisition. AMT, HJ, and JCJ participated in the conception of the study and supervised the work. All authors read and approved the final manuscript.

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Correspondence to Adolfo Martínez Tovar.

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Written informed consent was obtained from all subjects and the study was approved by the Ethics Committee of the Hospital General Mexico “Dr Eduardo Liceaga.” All the participants signed informed consent documents before enrollment. This study was conducted according to the Declaration of Helsinki. All parents/caregivers provided written informed consent for their children or adolescents to participate in the study and for a blood specimen to be withdrawn from them and other genetics analyses. Adolescents further provided written informed assent to participate in the study.

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The authors declare that they have no competing interests.

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Olarte Carrillo, I., García Laguna, A.I., De la Cruz Rosas, A. et al. High expression levels and the C3435T SNP of the ABCB1 gene are associated with lower survival in adult patients with acute myeloblastic leukemia in Mexico City. BMC Med Genomics 14, 251 (2021).

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