Purpose: On the basis of clinical studies showing that arsenic trioxide (As 2 O 3 ), via an apoptotic mechanism, and with minimal toxicity induces complete remission in patients with refractory acute promyelocytic leukemia and that multidrug-resistant and p53-mutated neuroblastoma cells are sensitive to As 2 O 3 both in vitro and in vivo, we searched for molecular mechanisms involved in the As 2 O 3 -induced neuroblastoma cell death.Experimental Design: We have studied the effect of As 2 O 3 on the expression and cellular localization of proteins involved in drug-induced death in two neuroblastoma cell lines with intact p53 and two with mutated p53, the latter two displaying multidrug resistance.Results: As 2 O 3 provoked Bax expression in all tested neuroblastoma cell lines, including SK-N-BE(2) cells with mutated p53 and LA-N-1 cells, which have a deleted p53. In all cell lines exposed to As 2 O 3 , p21 Bax was proteolytically cleaved in a calpain-dependent way into the more proapoptotic p18 Bax, which was detected exclusively in a mitochondria-enriched subcellular fraction. As 2 O 3 also caused an increase of cytoplasmic cytochrome c, translocation of antiapoptosis-inducing factor to the nuclei, and a slight activation of caspase 3. However, inhibition of caspase 3 did not prevent cell death, whereas inhibition of Bax cleavage was associated with a decreased As 2 O 3 -induced cell death.Conclusions: We show that multidrug-resistant neuroblastoma cells die after exposure to As 2 O 3 , independent of functional p53, suggesting activation of a cytotoxic pathway different from that induced by conventional chemotherapeutic agents. We further propose that proteolytic activation of Bax is an important event in As 2 O 3 -induced cell death.