Response to alkylation damage of fibroblast cells from patients with therapy-related myeloid neoplasms

Therapy-related myeloid neoplasms (t-MNs) are severe long-term consequences of chemo- and/or radiotherapy for a primary disease. It is generally accepted that genetic predisposition plays a major role in therapy-related leukemogenesis. The hypothesis that cellular response mechanisms to alkylation damage are deregulated in constitutional cells of patients with t-MNs due to predisposing genetic events was tested in this study. It was further examined whether genetic instability would also be a consequence of such a treatment. Therefore primary fibroblast cultures were established from skin biopsies from patients with t-MNs and matched healthy controls. These cultures were treated with the cyclophosphamide derivate phosphoramide mustard (PM), a bifunctional alkylating agent. The cellular response to alkylation damage was assessed with respect to cell viability, cell cycle regulation and chromosomal stability. Increased sensitivity to PM treatment could be demonstrated in 7/13 (54%) patient samples. IC50, IC75 and IC90 values as well as the percentage of viable cells at higher PM concentrations were significantly different when comparing patient and control groups. Both, fibroblast cells from patients and controls, properly induced cell cycle arrest following alkylating injury in the G2/M phase of the cell cycle. Gross genomic alterations like chromosome and chromatid breaks as well as structural and clonal numerical aberrations could be induced via PM treatment. The extent of induced changes per mitosis, however, was comparable in both, patient and control fibroblast cultures. These data demonstrate for the first time hypersensitivity of constitutional cells from patients with t-MNs to alkylation treatment indicating impaired DNA damage response and/or repair mechanisms. (author)