Alternative splicing of the primary glucocorticoid receptor (GR) transcript, resulting in glucocorticoid receptor alpha GRa, glucocorticoid receptor beta GRb and glucocorticoid receptor gamma GRc, may influence glucocorticoid (GC) resistance in childhood leukemia. To test this hypothesis, we determined GRa/b protein and GRa/b/c mRNA expression levels in 43 initial acute lymphoblastic leukemia (iALL), 10 initial myeloid leukemia (iAML), 11 relapsed ALL (rALL) samples and one rAML sample. The results were correlated with in vitro GC resistance. GRa mRNA correlated with protein expression (q ¼ 0.39-0.56, Po0.05), but the protein to mRNA ratio was median 2.2-fold lower in rALL than in iALL (Po0.05). GRb mRNA was median 137-fold lower than GRa mRNA and correlated with GRa mRNA expression (q ¼ 0.71, Po0.0001). GRb could not be detected at the protein level. GRc accounted for a median of 2.8% (range 0.95-7.4%) of all GR transcripts. GRa (protein and mRNA) and GRb (mRNA) expressions or GRa/GRb ratios did not correlate with in vitro GC resistance in iALL, but GRc (mRNA) did (q ¼ 0.52, P ¼ 0.007). These results suggest that GRb is not involved in GC resistance in childhood leukemia. The association between GRc expression and in vitro GC resistance in iALL and the decreased protein/mRNA ratio in rALL, a subgroup resistant to GCs, warrants further exploration.