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Blood, 1 July 2002, Vol. 100, No. 1, pp. 224-229
NEOPLASIA
Repair of DNA interstrand crosslinks as a mechanism of clinical
resistance to melphalan in multiple myeloma
Victoria J. Spanswick,
Charles Craddock,
Mallika Sekhar,
Prem Mahendra,
Paneesha Shankaranarayana,
R.
George Hughes,
Daniel Hochhauser, and
John A. Hartley
From the Cancer Research UK Drug-DNA Interactions
Research Group, Department of Oncology, Royal Free and University
College Medical School, London, United Kingdom; the Department of
Clinical Haematology and Stem Cell Transplantation, University
Hospital, Birmingham, United Kingdom; and the Department of Clinical
Haematology, West Middlesex University Hospital, Isleworth, United
Kingdom.
Melphalan is widely used as a preparative agent in patients with
multiple myeloma (MM) undergoing autologous stem cell transplantation (SCT). Although disease relapse is the major cause of death after a
melphalan-conditioned autograft, the mechanism remains unclear. Melphalan produces a number of DNA adducts with the DNA interstrand crosslink (ICL) considered to be the critical cytotoxic lesion. By
using a modification of the single-cell gel electrophoresis (Comet)
assay, we have measured formation and repair of DNA ICL in plasma cells
from melphalan- naive and melphalan-treated patients (ie, those who
have relapsed after a melphalan-conditioned autologous SCT or oral
melphalan therapy). Similar levels of dose-dependent DNA interstand
crosslinking were observed in cells from both melphalan-naive and
-treated patients. However, marked differences in ICL repair were
observed: cells from naive patients showed no repair, whereas those
from treated patients exhibited between 42% and 100% repair at 40 hours. In vitro sensitivity to melphalan in plasma cells was found to
correlate with ICL repair. These findings suggest that ICL repair may
be an important mechanism by which melphalan resistance emerges after
autologous SCT or oral therapy. This mechanism may have implications
for MM patients undergoing melphalan therapy.

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