Introduction: Autophagy was found to play a major role in the pathogenesis of acute lymphoblastic leukemia (ALL). In this study we investigated the expression of beclin-1, Bad, Bax, Bcl-2, and Bcl-xL in patients with ALL. Material and methods: This was a comparative study conducted on 100 ALL patients (age 8-15) divided into 2 groups. The first group, the ALL group, comprised ALL cases at their initial diagnosis (46 patients), while the second group, the Remission group, comprised in-remission cases (50 patients). mRNA expression levels in patients' blood samples were determined using real-time polymerase chain reaction (PCR). Results: Beclin-1 levels were significantly lower in the ALL group than in the Remission group (0.22 ±0.03 vs. 196.8 ±32.47; p = 0.001). Bad levels were significantly lower in the ALL group (1.0 ±0.18 vs. 163.6 ±36.2; p = 0.001), while Bax levels were significantly higher in the ALL group than in the Remission group (131.52 ±31.4 vs. 4.29 ±0.64; p = 0.001). Bcl-2 levels were significantly higher in the ALL group (2678.91 ±575.5 vs. 7.56 ±2.9; p = 0.001), and Bcl-xL levels were also significantly higher in the ALL group (142.99 ±24.43 vs. 0.99 ±0.2; p = 0.001). There was negative correlation between immunophenotyping with beclin-1 (r =-0.725; p < 0.001), while there was a positive correlation with Bcl-2 (r = 0.533; p < 0.001). Conclusions: Our findings reveal potential prognostic value for these markers in pediatric ALL, with regard to the delicate mutual balance among them.
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