Fig. 1. Apoptosis induction by lenalidomide is specific for 5q-deleted cells. (A) Cells from AML that evolved from MDS patients with (Center) or without (del) 5q and U937 cells (Left and Right) were exposed to lenalidomide, thalidomide, or vehicle (DMSO) at the concentrations indicated for 48 h before apoptosis was assessed by flow cytometry using Annexin-V/PI staining. Representative results are shown as the mean of the triplicate measurement ± SD from 1 patient. A total of 5 different MDS patients were tested. (B) Lenalidomide arrests 5q deleted cells in G 2 . Cells were treated with lenalidomide at the concentration of 1 μM for 48 h at 37°C and stained with propidium Iodide (PI) in BD Stain Buffer (10 6 /ml) before analysis on BD FACScan. (C) FISH analysis of haplo-deficiency of Cdc25C in (del)5q cells. A normal chromosome 5 showing FISH signals for D5S23/D5S721 (green) and Cdc25C (orange); the ideogram demonstrates the relative gene locations of EGR1 and Cdc25C in 5q31. Probes for EGR1 are commonly used to detect classical 5q deletions. The Right Inset illustrates D5S23/D5S721 and Cdc25C signal pattern for classical 5q deletions in interphase nuclei. (D) Reduced expression of Cdc25C and PP2Acα in bone marrow cells from patients with (del)5q by Q-PCR. RNA was purified from BM-MNC from patients with or without (del)5q as indicated. Relative expression levels of Cdc25C and PP2Acα were analyzed by Q-PCR to quantitate transcript level. Expression is normalized to the reference gene (GAPDH) and fold changes for Cdc25C and PP2Acα in patients are compared with the average data from non(del)5q cells (P < 0.001).