However, drug resistance in APL is still not clear and can be the result of multiple factors like drug resistance-related protein (ABCB1) and enzymes (glutathione-S-transferase (GST), topoisomerase II, protein kinase C), genetic alterations like Fms-like tyrosine kinase 3 (FLT3), Wilms tumor (WT1), IDH1, TP53, ASXL1, DNMT3A, CEBPA, IDH2, PTPN11, and miRNA alterations or drug resistance-related signal pathways like PI3K/AKT, NF-κB, PLCγ/Raf/Erk, and PKCα (Mahadevan and List, 2004; Zhang et al., 2019). This evidence concerns the gene DNMT3A and acute promyelocytic leukemia.