Multiple myeloma (MM) is an incurable disease despite an initial response-rate of >60% with conventional or high-dose chemotherapy. Glucocorticosteroids such as dexamethasone (DEX) and alkylating agents such as melphalan (MEL) are capable of inducing complete responses (CR) in >50% of MM patients, however, resistance to these drugs develop rapidly, in >90% of patients, within 2 years of treatment. The exact mechanism of resistance to these drugs is not known. We investigated the mechanism of resistance to DEX and MEL. In particular, we investigated the role of bcl-2 in development of resistance to these two drugs. We tested the role of bcl-2 by transfecting 2 low bcl-2-expressing myeloma cell lines, ARP-1 and 8226, with a bcl-2 expression vector and compared the effects of DEX and MEL on apoptosis, cell cycle distribution and the levels of proapoptotic (bax) and antiapoptotic (bcl-2, bclx) proteins. The results indicate that the two drugs act by a different mechanism with respect to all the parameters tested. While DEX-induced apoptosis was dependent on the level of bcl-2 expression, MEL-induced apoptosis was independent of bcl-2 levels. Treatment with DEX of the low bcl-2-expressing cells (DEX-sensitive) resulted in a rapid apoptosis from all phases of the cell cycle. In contrast, treatment with MEL blocked the cells in late-S/G2 phase of the cell cycle and caused substantial apoptosis, regardless of bcl-2 expression. Major differences between DEX and MEL were also observed with respect to their effects on the levels of bcl-2 and p53. Whereas DEX induced an early (day 1) downregulation of bcl-2 (only in the cells with low bcl-2), treatment with MEL did not affect bcl-2 levels. The levels of bclx and bax remained unchanged following treatment with either MEL or DEX. These results, taken together, suggest that the two drugs target different cellular components and induce apoptosis by different pathways, and that resistance to DEX is associated with low levels of bcl-2, whereas resistance to MEL is independent of bcl-2, and therefore, in vivo resistance to MEL, observed in MM patients, might involve other mechanisms rather than bcl-2.

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