Resistance to apoptosis may contribute to tumorigenesis and, in part, explains treatment failures in neoplastic diseases. We evaluated in vitro drug-induced apoptosis in leukemic cells using TdT-dependent labeling of DNA breaks with digoxigenine-dUTP and PI DNA staining in multiparameter flowcytometry. In cell lines developing drug resistance, a significant inhibition of proliferation and increased cell clearance via apoptosis was shown. Moreover, in drug resistant sub-lines and in blasts from AML patients, a variable apoptotic response to in vitro exposure to cytostatics was seen. Half of the studied AML cases were completely resistant to Novantrone-induced apoptosis with no correlation between sensitivity to Novantrone and bcl-2 expression. One case showed intraclonal heterogeneity with two coexisting populations: an immature blast population resistant to Novantrone and a differentiating blast population showing apoptotic response. Another case showed complete resistance to various cytostatics, but incubation with anti-CD95 monoclonal antibody resulted in a considerable apoptotic response. This case demonstrates that a lack of apoptotic response to cytostatics does not preclude sensitivity to other apoptotic stimuli. Our results confirm the role apoptosis plays in selection of drug-resistant clones and suggest different signaling pathways for apoptosis operating in various leukemic blasts.