Surface Evaluating Galectin-9, CTLA-4, and ABCB1 Gene Expression as Diagnostic and Prognostic Markers in Acute Lymphoblastic Leukemia

Acute Lymphoblastic Leukemia (ALL) remains a significant challenge in clinical hematology due to its complex mechanisms of immune evasion and resistance to treatment. The identification of reliable biomarkers is critical for improving diagnosis, prognosis, and therapeutic strategies. This study investigates the diagnostic and prognostic value of three biomarkers—Galectin-9 (Gal-9), Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), and ATP-binding cassette subfamily B member 1 (ABCB1) gene expression—in ALL patients. A total of 40 ALL patients (25 treated and 15 in the first diagnosis group) and 25 healthy controls were enrolled. Total RNA extracted from peripheral blood. Complementarydeoxyribonucleic acid (cDNA) synthesized with reverse transcriptase. The synthesized cDNA is amplified by using quantitative real-time polymerase chain reaction (RT-qPCR).The findings were normalized to the Beta-2-Microglobulin (β2M) reference gene. One-way ANOVA was performed to analyze gene expression between groups, while correlation and receiver operating characteristic (ROC) curve analysis assessed clinical parameters and diagnostic potential. Gal-9 levels were elevated in untreated patients (p < 0.05), whereas CTLA-4 expression was reduced in untreated patients (p < 0.01). ABCB1 levels were high in both groups (p < 0.05). Significant correlations were observed between CTLA-4 and ABCB1 (r = 0.81, p < 0.0001), and moderate correlations were found with Gal-9 (r = 0.35, p = 0.029) and ABCB1 (r = 0.38, p = 0.016). These findings underscore the potential of Gal-9, CTLA-4, and ABCB1 as valuable biomarkers in ALL, with CTLA-4 showing the highest diagnostic potential and ABCB1confirms its role in chemoresistance.