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Multidrug resistance (MDR) is a naturally occurring defense phenomenon by which cells battle against chemically foreign substances (xenobiotics), including some cytotoxic drugs. Membrane transporter hyperactivity is a major contributor to MDR and is the primary target of both diagnostic and therapeutic interventions. Multi-xenobiotic resistance can be exploited as several fluorescent indicator probes are extruded by the same drug transporters, making it possible to quantitatively measure MDR activity in cell lines and clinical samples by flow cytometry. The literature on MDR is reported in a number of different formats, making it difficult to compare data from various groups. This article will briefly review the pathomechanism, then focus upon the diagnostic approach, the interpretation of results from clinical samples and correlations with other variables. The authors believe that a standardized MDR assay, as well as a suitable monitoring test, may become a prognostic marker in several types of leukemia.