1 1072 101 CLONAL EVOLUTION IN A CHRONIC NEUTROPHILIC LEUKEMIA PATIENT. OBJECTIVES AND IMPORTANCE: CHRONIC NEUTROPHILIC LEUKEMIA (CNL) IS A DISTINCT MYELOPROLIFERATIVE NEOPLASM WITH A HIGH PREVALENCE (>80%) OF MUTATIONS IN THE COLONY-STIMULATING FACTOR 3 RECEPTOR (CSF3R); THESE MUTATIONS ACTIVATE THE RECEPTOR, LEADING TO THE PROLIFERATION OF NEUTROPHILS THAT ARE A HALLMARK OF CNL. CLINICAL PRESENTATION: WE PRESENT A MALE PATIENT WHO PRESENTED PERIPHERAL BLOOD LEUKOCYTOSIS. ON THE BASIS OF HIS MORPHOLOGICAL APPEARANCES AND MOLECULAR FINDINGS HE WAS DETERMINED TO HAVE A DIAGNOSIS OF CHRONIC NEUTROPHILIC LEUKEMIA. AT A FOLLOW-UP AT 7 MONTHS, IN ADDITION TO THE CSF3R C.2373G > A (P.W791*) TRUNCATED MUTATION, ANOTHER CSF3R MUTATION APPEARED AS C.1853C > T(P.T618I). DISCUSSION AND CONCLUSION: WE PRESENT THE FIRST PATIENT WITH A DIAGNOSIS OF CHRONIC NEUTROPHILIC LEUKEMIA WITH A C.2373G > A (P.W791*) TRUNCATED MUTATION OF CSF3R. THESE FINDINGS ELUCIDATE A NOVEL PARADIGM OF CNL PATHOGENESIS AND EXPLAIN HOW MUTATIONS DRIVE THE DEVELOPMENT OF THE DISEASE. THE ORDER OF ACQUISITION OF CSF3R MUTATIONS RELATIVE TO MUTATIONS IN EPIGENETIC MODIFIERS AND THE SPLICEOSOME HAVE BEEN DETERMINED ONLY IN ISOLATED CASE REPORTS; THUS, FURTHER WORK IS NEEDED TO UNDERSTAND THE IMPACT OF MUTATION CHRONOLOGY ON THE CLONAL EVOLUTION AND PROGRESSION OF CNL. 2019 2 1083 30 CNL AND ACML SHOULD BE CONSIDERED AS A SINGLE ENTITY BASED ON MOLECULAR PROFILES AND OUTCOMES. CHRONIC NEUTROPHILIC LEUKEMIA (CNL) AND ATYPICAL CHRONIC MYELOID LEUKEMIA (ACML) ARE RARE MYELOID DISORDERS THAT ARE CHALLENGING WITH REGARD TO DIAGNOSIS AND CLINICAL MANAGEMENT. TO STUDY THE SIMILARITIES AND DIFFERENCES BETWEEN THESE DISORDERS, WE UNDERTOOK A MULTICENTER INTERNATIONAL STUDY OF ONE OF THE LARGEST CASE SERIES (CNL, N = 24; ACML, N = 37 CASES, RESPECTIVELY), FOCUSING ON THE CLINICAL AND MUTATIONAL PROFILES (N = 53 WITH MOLECULAR DATA) OF THESE DISEASES. WE FOUND NO DIFFERENCES IN CLINICAL PRESENTATIONS OR OUTCOMES OF BOTH ENTITIES. AS PREVIOUSLY DESCRIBED, BOTH CNL AND ACML SHARE A COMPLEX MUTATIONAL PROFILE WITH MUTATIONS IN GENES INVOLVED IN EPIGENETIC REGULATION, SPLICING, AND SIGNALING PATHWAYS. APART FROM CSF3R, ONLY EZH2 AND TET2 WERE DIFFERENTIALLY MUTATED BETWEEN THEM. THE MOLECULAR PROFILES SUPPORT THE NOTION OF CNL AND ACML BEING A CONTINUUM OF THE SAME DISEASE THAT MAY FIT BEST WITHIN THE MYELODYSPLASTIC/MYELOPROLIFERATIVE NEOPLASMS. WE IDENTIFIED 4 HIGH-RISK MUTATED GENES, SPECIFICALLY CEBPA (BETA = 2.26, HAZARD RATIO [HR] = 9.54, P = .003), EZH2 (BETA = 1.12, HR = 3.062, P = .009), NRAS (BETA = 1.29, HR = 3.63, P = .048), AND U2AF1 (BETA = 1.75, HR = 5.74, P = .013) USING MULTIVARIATE ANALYSIS. OUR FINDINGS UNDERSCORE THE RELEVANCE OF MOLECULAR-RISK CLASSIFICATION IN CNL/ACML AS WELL AS THE IMPORTANCE OF CSF3R MUTATIONS IN THESE DISEASES. 2023 3 3107 64 GENOMICS OF CHRONIC NEUTROPHILIC LEUKEMIA. CHRONIC NEUTROPHILIC LEUKEMIA (CNL) IS A DISTINCT MYELOPROLIFERATIVE NEOPLASM WITH A HIGH PREVALENCE (>80%) OF MUTATIONS IN THE COLONY-STIMULATING FACTOR 3 RECEPTOR (CSF3R). THESE MUTATIONS ACTIVATE THE RECEPTOR, LEADING TO THE PROLIFERATION OF NEUTROPHILS THAT ARE A HALLMARK OF CNL. RECENTLY, THE WORLD HEALTH ORGANIZATION GUIDELINES HAVE BEEN UPDATED TO INCLUDE CSF3R MUTATIONS AS PART OF THE DIAGNOSTIC CRITERIA FOR CNL. BECAUSE OF THE HIGH PREVALENCE OF CSF3R MUTATIONS IN CNL, IT IS TEMPTING TO THINK OF THIS DISEASE AS BEING SOLELY DRIVEN BY THIS GENETIC LESION. HOWEVER, RECENT ADDITIONAL GENOMIC CHARACTERIZATION DEMONSTRATES THAT CNL HAS MUCH IN COMMON WITH OTHER CHRONIC MYELOID MALIGNANCIES AT THE GENETIC LEVEL, SUCH AS THE CLINICALLY RELATED DIAGNOSIS ATYPICAL CHRONIC MYELOID LEUKEMIA. THESE COMMONALITIES INCLUDE MUTATIONS IN SETBP1, SPLICEOSOME PROTEINS (SRSF2, U2AF1), AND EPIGENETIC MODIFIERS (TET2, ASXL1). SOME OF THESE SAME MUTATIONS ALSO HAVE BEEN CHARACTERIZED AS FREQUENT EVENTS IN CLONAL HEMATOPOIESIS OF INDETERMINATE POTENTIAL, SUGGESTING A MORE COMPLEX DISEASE EVOLUTION THAN WAS PREVIOUSLY UNDERSTOOD AND RAISING THE POSSIBILITY THAT AN AGE-RELATED CLONAL PROCESS OF PRELEUKEMIC CELLS COULD PRECEDE THE DEVELOPMENT OF CNL. THE ORDER OF ACQUISITION OF CSF3R MUTATIONS RELATIVE TO MUTATIONS IN SETBP1, EPIGENETIC MODIFIERS, OR THE SPLICEOSOME HAS BEEN DETERMINED ONLY IN ISOLATED CASE REPORTS; THUS, FURTHER WORK IS NEEDED TO UNDERSTAND THE IMPACT OF MUTATION CHRONOLOGY ON THE CLONAL EVOLUTION AND PROGRESSION OF CNL. UNDERSTANDING THE COMPLETE LANDSCAPE AND CHRONOLOGY OF GENOMIC EVENTS IN CNL WILL HELP IN THE DEVELOPMENT OF IMPROVED THERAPEUTIC STRATEGIES FOR THIS PATIENT POPULATION. 2017 4 409 26 ANALYSIS OF GENES ENCODING EPIGENETIC REGULATORS IN MYELOPROLIFERATIVE NEOPLASMS: COEXISTENCE OF A NOVEL SETBP1 MUTATION IN A PATIENT WITH A P.V617F JAK2 POSITIVE MYELOFIBROSIS. IN RECENT YEARS IT HAS BEEN SHOWN THAT THE CAUSES OF CHRONIC MYELOPROLIFERATIVE NEOPLASMS (MPNS) ARE MORE COMPLEX THAN A SIMPLE SIGNALING ABERRATION AND MANY OTHER MUTATED GENES AFFECTING DIFFERENT CELL PROCESSES HAVE BEEN DESCRIBED. FOR INSTANCE, MUTATIONS IN GENES ENCODING EPIGENETIC REGULATORS ARE MORE FREQUENT THAN EXPECTED. ONE OF THE LATEST GENES DESCRIBED AS MUTATED IS SET BINDING PROTEIN 1 (SETBP1). IN SILICO TOOLS HAVE REVEALED THAT THERE ARE SEVERAL HUMAN SETBP1 PARALOGOUS TO NUCLEAR RECEPTOR BINDING SET DOMAIN PROTEIN 1 (NSD1), NSD2 AND NSD3, FOR EXAMPLE, WHICH ARE ALSO INVOLVED IN THE DEVELOPMENT OF OTHER HEMATOLOGICAL MALIGNANCIES. THEREFORE, THE PRESENT STUDY ANALYZED THE MUTATIONAL STATUS OF NSD1, NSD2, NSD3 AND SETBP1 IN BCR-ABL1 NEGATIVE MPNS WITH OR WITHOUT JANUS KINASE 2 (JAK2) P.V617F MUTATION. THE PRESENT STUDY REVEALED THAT THE NSD GENES ARE NOT FREQUENTLY MUTATED IN MPNS. HOWEVER, A NOVEL SETBP1 MUTATION WAS IDENTIFIED IN A PATIENT WITH P.V617F JAK2 POSITIVE PRIMARY MYELOFIBROSIS. THESE RESULTS PROVIDE FURTHER INSIGHT INTO THE GENETIC COMPLEXITY OF MPNS. 2019 5 4549 29 MUTATION ANALYSIS OF THERAPY-RELATED MYELOID NEOPLASMS. WE ANALYZED THE GENETIC MUTATION STATUS OF 13 PATIENTS WITH THERAPY-RELATED MYELOID NEOPLASMS (T-MN). CONSISTENT WITH PREVIOUS REPORTS, T-MN CELLS PREFERENTIALLY ACQUIRED MUTATIONS IN TP53 AND EPIGENETIC MODIFYING GENES, INSTEAD OF MUTATIONS IN TYROSINE KINASE AND SPLICEOSOME GENES. FURTHERMORE, WE COMPARED THE MUTATION STATUS OF THREE T-MN CELLS WITH EACH OF THE INITIAL LYMPHOID MALIGNANT CELLS, AND IDENTIFIED COMMON MUTATIONS AMONG T-MN AND THE INITIAL MALIGNANT CELLS IN TWO PATIENTS. IN A PATIENT WHO DEVELOPED CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) AFTER FOLLICULAR LYMPHOMA (FL), TET2 MUTATION WAS IDENTIFIED IN BOTH CMML AND FL CELLS. NOTABLY, THE TET2 MUTATION WAS ALSO IDENTIFIED IN PERIPHERAL BLOOD CELLS IN THE DISEASE-FREE PERIOD WITH THE SAME ALLELIC FREQUENCY AS CMML AND FL CELLS, BUT NOT IN A GERM-LINE CONTROL, INDICATING THAT THE TET2 MUTATION OCCURRED SOMATICALLY IN THE INITIATING CLONE FOR BOTH MALIGNANT CELLS. ON THE OTHER HAND, A GERM-LINE MYB MUTATION WAS IDENTIFIED IN A PATIENT WHO DEVELOPED MYELODYSPLASTIC SYNDROMES (MDS) AFTER FL. THESE RESULTS SUGGEST THAT GERM-LINE DEPOSITION AND CLONAL HEMATOPOIESIS ARE CLOSELY ASSOCIATED WITH T-MN SUSCEPTIBILITY; HOWEVER, FURTHER ANALYSIS IS NECESSARY TO CLARIFY THE MECHANISM REQUIRED TO PROVIDE THE INITIATING CLONE WITH LINEAGE COMMITMENT AND CLONAL EXPANSION. 2018 6 1043 33 CLINICAL CHARACTERISTICS AND WHOLE EXOME/TRANSCRIPTOME SEQUENCING OF COEXISTING CHRONIC MYELOID LEUKEMIA AND MYELOFIBROSIS. MYELOPROLIFERATIVE NEOPLASMS (MPNS) ARE CLONAL HEMATOPOIETIC STEM CELL (HSC) DISORDERS THAT CAN BE CLASSIFIED ON THE BASIS OF GENETIC, CLINICAL, PHENOTYPIC FEATURES. GENETIC LESIONS SUCH AS JAK2 MUTATIONS AND BCR-ABL TRANSLOCATION ARE OFTEN MUTUALLY EXCLUSIVE IN MPN PATIENTS AND LEAD TO ESSENTIAL THROMBOCYTHEMIA, POLYCYTHEMIA VERA, OR MYELOFIBROSIS OR CHRONIC MYELOID LEUKEMIA, RESPECTIVELY. NEVERTHELESS, COEXISTENCE OF THESE GENETIC ABERRATIONS IN THE SAME PATIENT HAS BEEN REPORTED. WHETHER THESE ABERRATIONS OCCUR IN THE SAME STEM CELL OR A DIFFERENT CELL IS UNCLEAR, BUT AN UNSTABLE GENOME IN THE HSCS SEEMS TO BE THE COMMON ANTECEDENT. IN AN EFFORT TO CHARACTERIZE THE UNDERLYING GENETIC EVENTS THAT MIGHT CONTRIBUTE TO THE APPEARANCE OF MORE THAN ONE MPN IN A PATIENT, WE STUDIED NEOPLASTIC CELLS FROM PATIENTS WITH DUAL MPNS BY NEXT-GENERATION SEQUENCING. WE OBSERVED THAT MOST PATIENTS WITH TWO MPNS HARBORED MUTATIONS IN GENES KNOWN TO CONTRIBUTE TO CLONAL HEMATOPOIESIS THROUGH ALTERED EPIGENETIC REGULATION SUCH AS TET2, ASXL1/2, SRSF2, AND IDH2 AT VARYING FREQUENCIES (1%-47%). IN ADDITION, WE FOUND THAT SOME PATIENTS ALSO HARBORED ONCOGENIC MUTATIONS IN N/KRAS, TP53, BRAF, EZH2, AND GNAS AT LOW FREQUENCIES, WHICH PROBABLY REPRESENT CLONAL EVOLUTION. THESE FINDINGS SUPPORT THE HYPOTHESIS THAT HEMATOPOIETIC CELLS FROM MPN PATIENTS HARBOR MULTIPLE GENETIC ABERRATIONS, SOME OF WHICH CAN CONTRIBUTE TO CLONAL DOMINANCE. ACQUIRING MUTATIONS IN JAK2/CALR/MPL OR THE BCR-ABL TRANSLOCATION PROBABLY DRIVE THE ONCOGENIC PHENOTYPE TOWARDS A SPECIFIC MPN. FURTHER, WE PROPOSE THAT THE ACQUISITION OF BCR-ABL IN THESE PATIENTS IS FREQUENTLY A SECONDARY EVENT RESULTING FROM AN UNSTABLE GENOME. 2017 7 2935 19 GENETIC ALTERATION ASSOCIATED WITH CHRONIC LYMPHOCYTIC LEUKEMIA. THE GENETICS OF B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA (B-CLL) DIFFER CONSIDERABLY FROM MOST OTHER FORMS OF HEMATOLOGIC MALIGNANCY WHICH ARE USUALLY CHARACTERIZED BY CHROMOSOME TRANSLOCATIONS. B-CLL TYPICALLY CONTAINS CHROMOSOMAL DELETIONS AND CHROMOSOMES 13Q14 AND 11Q22-->Q23 ARE THE MOST COMMON. THESE TWO REGIONS APPEAR TO SHARE A COMMON ANCESTRAL ORIGIN (AUER ET AL., 2007B). OVERALL, CHROMOSOMAL ABNORMALITIES CAN BE FOUND IN THE MAJORITY OF PATIENTS WITH B-CLL WHEN USING SENSITIVE TECHNIQUES (DOHNERET AL., 2000) AND POSSIBLY REFLECTS AN UNDERLYING PREDISPOSITION, WITH A SMALL BUT SIGNIFICANT NUMBER OF FAMILIAL CASES. ALTHOUGH SINGLE AND CONSISTENT ABNORMALITIES ARE MOST COMMON, MULTIPLE REARRANGEMENTS CAN OCCUR, OFTEN WITH DISEASE PROGRESSION (FEGANETAL., 1995; DOHNER ET AL., 2000). REGIONS OF RECURRENT DELETION SUGGEST THE PRESENCE OF TUMOR SUPPRESSOR GENES IF FOLLOWING KNUDSON'S THEORETICAL 2-HIT MODEL. HOWEVER, DESPITE EXTENSIVE SEQUENCING ANALYSIS OVER THE LAST DECADE AND LACK OF PATHOGENIC MUTATIONS IDENTIFIED, THERE HAS BEEN A MOVE AWAY FROM THIS SUGGESTED HYPOTHESIS AND ALTERNATIVE MECHANISMS OF GENE INACTIVATION INVOLVING EPIGENETIC SILENCING OR HAPLOINSUFFICIENCY MAY BE CONSIDERED AS MORE LIKELY IN THIS DISEASE. THIS REVIEW FOCUSES ON THE COMMON GENETIC ABNORMALITIES IN B-CLL AND RELATES THEM TO SOME OF THE MORE RECENT HYPOTHESES ON INACTIVATION OF GENES WITHIN THESE REGIONS OF DELETION. 2007 8 1260 25 CURRENT VIEWS ON THE INTERPLAY BETWEEN TYROSINE KINASES AND PHOSPHATASES IN CHRONIC MYELOID LEUKEMIA. CHRONIC MYELOID LEUKEMIA (CML) IS A MYELOPROLIFERATIVE DISORDER CHARACTERIZED BY BCR-ABL1 ONCOGENE EXPRESSION. THIS DYSREGULATED PROTEIN-TYROSINE KINASE (PTK) IS KNOWN AS THE PRINCIPAL DRIVER OF THE DISEASE AND IS TARGETED BY TYROSINE KINASE INHIBITORS (TKIS). EXTENSIVE DOCUMENTATION HAS ELUCIDATED HOW THE TRANSFORMATION OF MALIGNANT CELLS IS CHARACTERIZED BY MULTIPLE GENETIC/EPIGENETIC CHANGES LEADING TO THE LOSS OF TUMOR-SUPPRESSOR GENES FUNCTION OR PROTO-ONCOGENES EXPRESSION. THE IMPAIRMENT OF ADEQUATE LEVELS OF SUBSTRATES PHOSPHORYLATION, THUS AFFECTING THE BALANCE PTKS AND PROTEIN PHOSPHATASES (PPS), REPRESENTS A WELL-ESTABLISHED CELLULAR MECHANISM TO ESCAPE FROM SELF-LIMITING SIGNALS. IN THIS REVIEW, WE FOCUS OUR ATTENTION ON THE CHARACTERIZATION OF AND INTERACTIONS BETWEEN PTKS AND PPS, EMPHASIZING THEIR BIOLOGICAL ROLES IN DISEASE EXPANSION, THE REGULATION OF LSCS AND TKI RESISTANCE. WE DECIDED TO SEPARATE THOSE PPS THAT HAVE BEEN VALIDATED IN PRIMARY CELL MODELS OR LEUKEMIA MOUSE MODELS FROM THOSE WHOSE STUDIES HAVE BEEN PERFORMED ONLY IN CELL LINES (AND, THUS, REQUIRE VALIDATION), AS THERE MAY BE DIFFERENCES IN THE MANNER THAT THE ASSOCIATED PATHWAYS ARE MODIFIED UNDER THESE TWO CONDITIONS. THIS REVIEW SUMMARIZES THE ROLES OF DIVERSE PPS, WITH HOPE THAT BETTER KNOWLEDGE OF THE INTERPLAY AMONG PHOSPHATASES AND KINASES WILL EVENTUALLY RESULT IN A BETTER UNDERSTANDING OF THIS DISEASE AND CONTRIBUTE TO ITS ERADICATION. 2021 9 4837 25 ONCOGENIC GENE EXPRESSION AND EPIGENETIC REMODELING OF CIS-REGULATORY ELEMENTS IN ASXL1-MUTANT CHRONIC MYELOMONOCYTIC LEUKEMIA. MYELOID NEOPLASMS ARE CLONAL HEMATOPOIETIC STEM CELL DISORDERS DRIVEN BY THE SEQUENTIAL ACQUISITION OF RECURRENT GENETIC LESIONS. TRUNCATING MUTATIONS IN THE CHROMATIN REMODELER ASXL1 (ASXL1(MT)) ARE ASSOCIATED WITH A HIGH-RISK DISEASE PHENOTYPE WITH INCREASED PROLIFERATION, EPIGENETIC THERAPEUTIC RESISTANCE, AND POOR SURVIVAL OUTCOMES. WE PERFORMED A MULTI-OMICS INTERROGATION TO DEFINE GENE EXPRESSION AND CHROMATIN REMODELING ASSOCIATED WITH ASXL1(MT) IN CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML). ASXL1(MT) ARE ASSOCIATED WITH A LOSS OF REPRESSIVE HISTONE METHYLATION AND INCREASE IN PERMISSIVE HISTONE METHYLATION AND ACETYLATION IN PROMOTER REGIONS. ASXL1(MT) ARE FURTHER ASSOCIATED WITH DE NOVO ACCESSIBILITY OF DISTAL ENHANCERS BINDING ETS TRANSCRIPTION FACTORS, TARGETING IMPORTANT LEUKEMOGENIC DRIVER GENES. CHROMATIN REMODELING OF PROMOTERS AND ENHANCERS IS STRONGLY ASSOCIATED WITH GENE EXPRESSION AND HETEROGENOUS AMONG OVEREXPRESSED GENES. THESE RESULTS PROVIDE A COMPREHENSIVE MAP OF THE TRANSCRIPTOME AND CHROMATIN LANDSCAPE OF ASXL1(MT) CMML, FORMING AN IMPORTANT FRAMEWORK FOR THE DEVELOPMENT OF NOVEL THERAPEUTIC STRATEGIES TARGETING ONCOGENIC CIS INTERACTIONS. 2022 10 2469 12 EPIGENETIC TRAJECTORIES OF THE PREMALIGNANT-TO-MALIGNANT TRANSITION OF CHRONIC LYMPHOCYTIC LEUKEMIA. KRETZMER AND COLLEAGUES SHOW THAT THE TRANSITION TO ALTERED METHYLOME OCCURS VERY EARLY IN CHRONIC LYMPHOCYTIC LEUKEMIA, AND ONCE ACQUIRED, IT IS A CLONAL AND EXTREMELY STABLE CHANGE. HOWEVER, THE PRECISE TIME POINT WHEN THE LEUKEMIC CLONE STARTS DEVIATING SIGNIFICANTLY FROM THE NORMAL B-CELL DIFFERENTIATION TRAJECTORY IS STILL ELUSIVE. SEE RELATED ARTICLE BY KRETZMER ET AL., P. 54. 2021 11 6222 15 THE LANDSCAPE OF SOMATIC MUTATIONS IN LYMPHOBLASTOID CELL LINES. SOMATIC MUTATIONS HAVE IMPORTANT BIOLOGICAL RAMIFICATIONS WHILE EXERTING SUBSTANTIAL RATE, TYPE, AND GENOMIC LOCATION HETEROGENEITY. YET, THEIR SPORADIC OCCURRENCE MAKES THEM DIFFICULT TO STUDY AT SCALE AND ACROSS INDIVIDUALS. LYMPHOBLASTOID CELL LINES (LCLS), A MODEL SYSTEM FOR HUMAN POPULATION AND FUNCTIONAL GENOMICS, HARBOR LARGE NUMBERS OF SOMATIC MUTATIONS AND HAVE BEEN EXTENSIVELY GENOTYPED. BY COMPARING 1,662 LCLS, WE REPORT THAT THE MUTATIONAL LANDSCAPE OF THE GENOME VARIES ACROSS INDIVIDUALS IN TERMS OF THE NUMBER OF MUTATIONS, THEIR GENOMIC LOCATIONS, AND THEIR SPECTRA; THIS VARIATION MAY ITSELF BE MODULATED BY SOMATIC TRANS-ACTING MUTATIONS. MUTATIONS ATTRIBUTED TO THE TRANSLESION DNA POLYMERASE ETA FOLLOW TWO DIFFERENT MODES OF FORMATION, WITH ONE MODE ACCOUNTING FOR THE HYPERMUTABILITY OF THE INACTIVE X CHROMOSOME. NONETHELESS, THE DISTRIBUTION OF MUTATIONS ALONG THE INACTIVE X CHROMOSOME APPEARS TO FOLLOW AN EPIGENETIC MEMORY OF THE ACTIVE FORM. 2023 12 1070 22 CLONAL ARCHITECTURE OF CHRONIC MYELOMONOCYTIC LEUKEMIAS. GENOMIC STUDIES IN CHRONIC MYELOID MALIGNANCIES, INCLUDING MYELOPROLIFERATIVE NEOPLASMS (MPN), MYELODYSPLASTIC SYNDROMES (MDS), AND MPN/MDS, HAVE IDENTIFIED COMMON MUTATIONS IN GENES ENCODING SIGNALING, EPIGENETIC, TRANSCRIPTION, AND SPLICING FACTORS. IN THE PRESENT STUDY, WE INTERROGATED THE CLONAL ARCHITECTURE BY MUTATION-SPECIFIC DISCRIMINATION ANALYSIS OF SINGLE-CELL-DERIVED COLONIES IN 28 PATIENTS WITH CHRONIC MYELOMONOCYTIC LEUKEMIAS (CMML), THE MOST FREQUENT MPN/MDS. THIS ANALYSIS REVEALS A LINEAR ACQUISITION OF THE STUDIED MUTATIONS WITH LIMITED BRANCHING THROUGH LOSS OF HETEROZYGOSITY. SERIAL ANALYSIS OF UNTREATED AND TREATED SAMPLES DEMONSTRATES A DYNAMIC ARCHITECTURE ON WHICH MOST CURRENT THERAPEUTIC APPROACHES HAVE LIMITED EFFECTS. THE MAIN DISEASE CHARACTERISTICS ARE EARLY CLONAL DOMINANCE, ARISING AT THE CD34(+)/CD38(-) STAGE OF HEMATOPOIESIS, AND GRANULOMONOCYTIC DIFFERENTIATION SKEWING OF MULTIPOTENT AND COMMON MYELOID PROGENITORS. COMPARISON OF CLONAL EXPANSIONS OF TET2 MUTATIONS IN MDS, MPN, AND CMML, TOGETHER WITH FUNCTIONAL INVALIDATION OF TET2 IN SORTED PROGENITORS, SUGGESTS A CAUSATIVE LINK BETWEEN EARLY CLONAL DOMINANCE AND SKEWED GRANULOMONOCYTIC DIFFERENTIATION. ALTOGETHER, EARLY CLONAL DOMINANCE MAY DISTINGUISH CMML FROM OTHER CHRONIC MYELOID NEOPLASMS WITH SIMILAR GENE MUTATIONS. 2013 13 3316 24 HISTIOCYTIC SARCOMA AS A SECONDARY MALIGNANCY: PATHOBIOLOGY, DIAGNOSIS, AND TREATMENT. HISTIOCYTIC SARCOMA (HS) IS AN EXTREMELY RARE NON-LANGERHANS CELL DISORDER WITH AN AGGRESSIVE COURSE AND LIMITED TREATMENT OPTIONS. RECENT ADVANCES IN MOLECULAR/GENETIC SEQUENCING HAVE SUGGESTED A COMMON CLONAL ORIGIN BETWEEN VARIOUS HEMATOLYMPHOID DISORDERS AND CASES OF SECONDARY HS. DERIVING CONCLUSIONS FROM PREVIOUSLY REPORTED CASES OF HS ARISING SECONDARILY TO CERTAIN HEMATOLYMPHOID DISORDERS, HERE WE HAVE TRIED TO PROVIDE INSIGHT INTO THE MECHANISMS INFLUENCING THIS EVOLUTION. WE ALSO DISCUSS A CLINICAL CASE OF A 72-YEAR-OLD MAN WITH A DIAGNOSIS OF CHRONIC MYELOID LEUKEMIA (CML), PRESENTING SUBSEQUENTLY WITH A HETEROGENEOUS LIVER MASS POSITIVE WITH A DIAGNOSIS OF HS. THE LIVER MASS SHOWED A RETAINED BCR-ABL1 TRANSLOCATION SUGGESTING CLONALITY BETWEEN THE CML AND HS. AS SEEN IN OUR CASE AND OTHER REPORTED CASES OF HS DERIVED SECONDARILY, THE CONCURRENT EXPRESSION OF IMMUNOGLOBULIN HEAVY (IGH)-/LIGHT-CHAIN REARRANGEMENTS OR CYTOGENETIC MARKERS COMMON TO THE PRIMARY MALIGNANCY SUGGESTS AN EVOLUTIONARY MECHANISM INVOLVING LINEAGE SWITCHING THAT COULD POTENTIALLY BE INFLUENCED BY GENETIC OR EPIGENETIC CUES WHICH MAY OCCUR AT THE LEVEL OF A PROGENITOR OR THE MALIGNANT CELL ITSELF. 2016 14 5249 26 PROGRAMMED CELL DEATH-1 PATHWAY INHIBITION IN MYELOID MALIGNANCIES: IMPLICATIONS FOR MYELOPROLIFERATIVE NEOPLASMS. MYELOPROLIFERATIVE NEOPLASMS (MPNS) ARE CLONAL HEMATOPOIETIC DISEASES THAT BELONG TO THE SPECTRUM OF MYELOID MALIGNANCIES (MYMS), WHICH ALSO INCLUDE MYELODYSPLASTIC SYNDROMES (MDS), ACUTE MYELOID LEUKEMIA (AML), AND CHRONIC MYELOGENOUS LEUKEMIA (CML). WHILE HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IS A POTENTIALLY CURATIVE THERAPEUTIC APPROACH TO MANY MYMS, THE ASSOCIATED MORBIDITY AND MORTALITY HAVE NECESSITATED THE DEVELOPMENT OF NON-HSCT THERAPEUTICS FOR SYMPTOM MANAGEMENT AND DISEASE COURSE MODIFICATION. IMMUNE CHECKPOINT INHIBITION, IN PARTICULAR ALONG THE PROGRAMMED CELL DEATH PROTEIN 1 (PD-1)/B7-H1 (PD-L1) AXIS, IS AN ESTABLISHED STRATEGY IN SOLID TUMORS WITH POTENTIAL AS AN ADJUNCTIVE THERAPY IN HEMATOLOGIC MALIGNANCIES. SEMINAL STUDIES SUGGEST THAT THE PRO-INFLAMMATORY MICROENVIRONMENT OF MYMS CAN SUPPRESS T LYMPHOCYTE-MEDIATED IMMUNITY VIA PD-1 SIGNALING AND THAT RESPONSE TO MAINSTAY EPIGENETIC THERAPIES FOR MYMS MAY BE GOVERNED BY PD-1 GENE REGULATION. ALTHOUGH THE ROLE OF PD-1 SIGNALING IN MPN PATHOGENESIS AND PROGRESSION IS AS YET UNCLEAR, RESEARCH IN MPN PATIENTS HAS REVEALED EXPANSION OF MYELOID-DERIVED SUPPRESSOR CELLS (MDSCS), WHICH MAY EFFECT HOST IMMUNE TOLERANCE OF TUMOR VIA TEMPORALLY AND SPATIALLY SPECIFIC ACTIVATION OF PD-1/PD-L1 SIGNALING. THE CURRENT UNDERSTANDING OF IMMUNE DYSFUNCTION IN MPNS AND ANALOGOUS MYMS OFFERS A COMPELLING RATIONALE TO STUDY PD-1/PD-L1 INHIBITION IN PATIENTS AS A NOVEL TREATMENT OPTION. 2017 15 1628 25 DNMT3A AND TET2 DOMINATE CLONAL HEMATOPOIESIS AND DEMONSTRATE BENIGN PHENOTYPES AND DIFFERENT GENETIC PREDISPOSITIONS. AGE-ASSOCIATED CLONAL HEMATOPOIESIS CAUSED BY ACQUIRED MUTATIONS IN MYELOID CANCER-ASSOCIATED GENES IS HIGHLY PREVALENT IN THE NORMAL POPULATION. ITS ETIOLOGY, BIOLOGICAL IMPACT ON HEMATOPOIESIS, AND ONCOGENIC RISK IS POORLY DEFINED AT THIS TIME. TO GAIN INSIGHT INTO THIS PHENOMENON, WE ANALYZED A COHORT OF 2530 RELATED AND UNRELATED HEMATOLOGICALLY NORMAL INDIVIDUALS (AGES 55 TO 101 YEARS). WE USED A SENSITIVE GENE-TARGETED DEEP SEQUENCING APPROACH TO GAIN PRECISION ON THE EXACT PREVALENCE OF DRIVER MUTATIONS AND THE PROPORTIONS OF AFFECTED GENES. MUTATIONAL STATUS WAS CORRELATED WITH BIOLOGICAL PARAMETERS. WE REPORT A HIGHER OVERALL PREVALENCE OF DRIVER MUTATIONS (13.7%), WHICH OCCURRED MOSTLY (93%) IN DNMT3A OR TET2 AND WERE HIGHLY AGE-CORRELATED. MUTATION IN THESE 2 GENES HAD SOME DISTINCTIVE EFFECTS ON END POINTS. TET2 MUTATIONS WERE MORE AGE-DEPENDENT, ASSOCIATED WITH A MODEST NEUTROPENIC EFFECT (9%, P = .012), DEMONSTRATED FAMILIAL AGGREGATION, AND ASSOCIATED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE. MUTATIONS IN DNMT3A HAD NO IMPACT ON BLOOD COUNTS OR INDICES. MUTATIONAL BURDEN OF BOTH GENES CORRELATED WITH X-INACTIVATION SKEWING BUT NO SIGNIFICANT ASSOCIATION WITH AGE-ADJUSTED TELOMERE LENGTH REDUCTION WAS DOCUMENTED. THE DISCORDANCE BETWEEN THE HIGH PREVALENCE OF MUTATIONS IN THESE 2 GENES AND THEIR LIMITED BIOLOGICAL IMPACT RAISE THE QUESTION OF THE POTENTIAL ROLE OF DYSREGULATED EPIGENETIC MODIFIERS IN NORMAL AGING HEMATOPOIESIS, WHICH MAY INCLUDE SUPPORT TO FAILING HEMATOPOIESIS. 2017 16 3537 31 IMMUNE DYSREGULATION IN KABUKI SYNDROME: A CASE REPORT OF EVANS SYNDROME AND HYPOGAMMAGLOBULINEMIA. KABUKI SYNDROME (KS) IS A RARE MULTISYSTEMIC DISEASE DUE TO MUTATIONS IN THE KMT2D OR KDM6A GENES, WHICH ACT AS EPIGENETIC MODULATORS OF DIFFERENT PROCESSES, INCLUDING IMMUNE RESPONSE. THE SYNDROME IS CHARACTERIZED BY ANOMALIES IN MULTIPLE ORGAN SYSTEMS, AND IT IS ASSOCIATED WITH AUTOIMMUNE AND INFLAMMATORY DISORDERS, AND AN UNDERLYING IMMUNOLOGICAL PHENOTYPE CHARACTERIZED BY IMMUNODEFICIENCY AND IMMUNE DYSREGULATION. UP TO 17% OF KS PATIENTS PRESENT WITH IMMUNE THROMBOCYTOPENIA CHARACTERIZED BY A SEVERE, CHRONIC OR RELAPSING COURSE, AND OFTEN ASSOCIATED TO OTHER HEMATOLOGICAL AUTOIMMUNE DISEASES INCLUDING AUTOIMMUNE HEMOLYTIC ANEMIA, EVENTUALLY RESULTING IN EVANS SYNDROME (ES). A 23-YEAR-OLD WOMAN, CLINICALLY DIAGNOSED WITH KS AND PRESENTING FROM THE AGE OF 3 YEARS WITH ES WAS REFERRED TO THE RARE DISEASES CENTRE OF OUR PEDIATRIC DEPARTMENT FOR CORTICOSTEROID-INDUCED HYPERGLYCEMIA. SEVERAL ES RELAPSES AND RECURRENT RESPIRATORY INFECTIONS IN THE PREVIOUS YEARS WERE REPORTED. SEVERE HYPOGAMMAGLOBULINEMIA, SPLENOMEGALY AND SIGNS OF CHRONIC LUNG INFLAMMATION WERE DIAGNOSED ONLY AT THE TIME OF OUR OBSERVATION. SUPPORTIVE TREATMENT WITH AMOXICILLIN-CLAVULANATE PROPHYLAXIS AND RECOMBINANT HUMAN HYALURONIDASE-FACILITATED SUBCUTANEOUS IMMUNOGLOBULIN REPLACEMENT WERE IMMEDIATELY STARTED. IN KS PATIENTS, THE FAILURE OF B-CELL DEVELOPMENT AND THE LACK OF AUTOREACTIVE IMMUNE CELLS SUPPRESSION CAN LEAD TO IMMUNODEFICIENCY AND AUTOIMMUNITY THAT MAY BE UNDIAGNOSED FOR A LONG TIME. OUR PATIENT'S CASE IS PARADIGMATIC SINCE SHE PRESENTED WITH PREVENTABLE MORBIDITY AND SEVERE LUNG DISEASE YEARS AFTER DISEASE ONSET. THIS CASE EMPHASIZES THE IMPORTANCE OF SUSPECTING IMMUNE DYSREGULATION IN KS. PATHOGENESIS AND IMMUNOLOGICAL COMPLICATIONS OF KS ARE DISCUSSED. MOREOVER, THE NEED TO PERFORM IMMUNOLOGIC EVALUATIONS IS HIGHLIGHTED BOTH AT THE TIME OF KS DIAGNOSIS AND DURING DISEASE FOLLOW-UP, IN ORDER TO ALLOW PROPER TREATMENT WHILE INTERCEPTING AVOIDABLE MORBIDITY IN THESE PATIENTS. 2023 17 5782 26 SPLICING ANOMALIES IN MYELOPROLIFERATIVE NEOPLASMS: PAVING THE WAY FOR NEW THERAPEUTIC VENUES. SINCE THE DISCOVERY OF SPLICEOSOME MUTATIONS IN MYELOID MALIGNANCIES, ABNORMAL PRE-MRNA SPLICING, WHICH HAS BEEN WELL STUDIED IN VARIOUS CANCERS, HAS ATTRACTED NOVEL INTEREST IN HEMATOLOGY. HOWEVER, DESPITE THE COMMON OCCURRENCE OF SPLICEOSOME MUTATIONS IN MYELO-PROLIFERATIVE NEOPLASMS (MPN), NOT MUCH IS KNOWN REGARDING THE CHARACTERIZATION AND MECHANISMS OF SPLICING ANOMALIES IN MPN. IN THIS ARTICLE, WE REVIEW THE CURRENT SCIENTIFIC LITERATURE REGARDING "SPLICING AND MYELOPROLIFERATIVE NEOPLASMS". WE FIRST ANALYSE THE CLINICAL SERIES REPORTING SPLICEOSOME MUTATIONS IN MPN AND THEIR CLINICAL CORRELATES. WE THEN PRESENT THE CURRENT KNOWLEDGE ABOUT MOLECULAR MECHANISMS BY WHICH THESE MUTATIONS PARTICIPATE IN THE PATHOGENESIS OF MPN OR OTHER MYELOID MALIGNANCIES. BESIDE SPLICEOSOME MUTATIONS, SPLICING ANOMALIES HAVE BEEN DESCRIBED IN MYELOPROLIFERATIVE NEOPLASMS, AS WELL AS IN ACUTE MYELOID LEUKEMIAS, A DREADFUL COMPLICATION OF THESE CHRONIC DISEASES. BASED ON SPLICING ANOMALIES REPORTED IN CHRONIC MYELOGENOUS LEUKEMIA AS WELL AS IN ACUTE LEUKEMIA, AND THE MECHANISMS PRESIDING SPLICING DEREGULATION, WE PROPOSE THAT ABNORMAL SPLICING PLAYS A MAJOR ROLE IN THE EVOLUTION OF MYELOPROLIFERATIVE NEOPLASMS AND MAY BE THE TARGET OF SPECIFIC THERAPEUTIC STRATEGIES. 2020 18 6852 27 [MYELOPROLIFERATIVE NEOPLASMS: UPDATES ON MOLECULAR PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT STRATEGIES]. MYELOPROLIFERATIVE NEOPLASMS (MPNS) ARE CHRONIC HEMATOPOIETIC STEM CELL DISORDERS, INCLUDING POLYCYTHEMIA VERA, ESSENTIAL THROMBOCYTOSIS, AND PRIMARY MYELOFIBROSIS. THE JAK2V617F MUTATION WAS IDENTIFIED IN 2005, FOLLOWED BY THE DISCOVERY OF THE JAK2 EXON12, MPNW515 MUTATION, AND CALR MUTATION. ABOUT 90% OF PATIENTS WITH BCR/ABL NEGATIVE MPNS HAVE BEEN SHOWN TO HAVE ONE OF THESE DRIVER MUTATIONS. IN ADDITION, MUTATIONS IN EPIGENETIC REGULATORS AND RNA SPLICING GENES WERE FOUND TO CO-EXIST WITH DRIVER MUTATIONS AND TO PLAY CRITICAL ROLES IN THE DISEASE PROGRESSION OF MPNS. CURRENTLY, EVALUATIONS OF THESE GENE MUTATIONS ARE ESSENTIAL FOR THE DIAGNOSIS OF MPNS, AND ARE ALSO NECESSARY FOR ESTIMATING THE CLINICAL COURSE AND THE RISK OF DISEASE PROGRESSION. GUIDELINES FOR THE MANAGEMENT OF MPNS WERE BASED ON THE RESULTS OF LARGE CLINICAL TRIALS. FURTHERMORE, RECENT ADVANCEMENTS IN UNDERSTANDING THE PATHOGENESIS OF MPNS ARE ANTICIPATED TO PROMOTE THE DEVELOPMENT OF MPN-TARGETED THERAPIES SUCH AS JAK2 INHIBITORS. CLINICAL TRIALS FOR PATIENTS WITH PMF AND PV HAVE CONFIRMED THE EFFICACIES OF JAK2 INHIBITORS. 2016 19 1076 27 CLONAL HEMATOPOIESIS IN MYELOPROLIFERATIVE NEOPLASMS CONFERS A PREDISPOSITION TO BOTH THROMBOSIS AND CANCER. PURPOSE OF REVIEW: THIS REVIEW FOCUSES ON VASCULAR COMPLICATIONS ASSOCIATED WITH CHRONIC MYELOPROLIFERATIVE NEOPLASMS (MPN) AND MORE SPECIFICALLY AIMS TO DISCUSS THE CLINICAL AND BIOLOGICAL EVIDENCE SUPPORTING THE EXISTENCE OF A LINK BETWEEN CLONAL HEMATOPOIESIS, CARDIOVASCULAR EVENTS (CVE), AND SOLID CANCER (SC). RECENT FINDINGS: THE MPN NATURAL HISTORY IS DRIVEN BY UNCONTROLLED CLONAL MYELOPROLIFERATION SUSTAINED BY ACQUIRED SOMATIC MUTATIONS IN DRIVER (JAK2, CALR, AND MPL) AND NON-DRIVER GENES, INVOLVING EPIGENETIC (E.G., TET2, DNMT3A) REGULATORS, CHROMATIN REGULATOR GENES (E.G., ASXL1, EZH2), AND SPLICING MACHINERY GENES (E.G., SF3B1). THE GENOMIC ALTERATIONS AND ADDITIONAL THROMBOSIS ACQUIRED RISK FACTORS ARE DETERMINANTS FOR CVE. THERE IS EVIDENCE THAT CLONAL HEMATOPOIESIS CAN ELICIT A CHRONIC AND SYSTEMIC INFLAMMATION STATUS THAT ACTS AS DRIVING FORCE FOR THE DEVELOPMENT OF THROMBOSIS, MPN EVOLUTION, AND SECOND CANCER (SC). THIS NOTION MAY EXPLAIN THE MECHANISM THAT LINKS ARTERIAL THROMBOSIS IN MPN PATIENTS AND SUBSEQUENT SOLID TUMORS. IN THE LAST DECADE, CLONAL HEMATOPOIESIS OF INDETERMINATE POTENTIAL (CHIP) HAS BEEN DETECTED IN THE GENERAL POPULATION PARTICULARLY IN THE ELDERLY AND INITIALLY FOUND IN MYOCARDIAL INFARCTION AND STROKE, RISING THE HYPOTHESIS THAT THE INFLAMMATORY STATUS CHIP-ASSOCIATED COULD CONFER PREDISPOSITION TO BOTH CARDIOVASCULAR DISEASES AND CANCER. IN SUMMARY, CLONAL HEMATOPOIESIS IN MPN AND CHIP CONFER A PREDISPOSITION TO CARDIOVASCULAR EVENTS AND CANCER THROUGH CHRONIC AND SYSTEMIC INFLAMMATION. THIS ACQUISITION COULD OPEN NEW AVENUES FOR ANTITHROMBOTIC THERAPY BOTH IN MPNS AND IN GENERAL POPULATION BY TARGETING BOTH CLONAL HEMATOPOIESIS AND INFLAMMATION. 2023 20 5641 20 SETBP1 INDUCES TRANSCRIPTION OF A NETWORK OF DEVELOPMENT GENES BY ACTING AS AN EPIGENETIC HUB. SETBP1 VARIANTS OCCUR AS SOMATIC MUTATIONS IN SEVERAL HEMATOLOGICAL MALIGNANCIES SUCH AS ATYPICAL CHRONIC MYELOID LEUKEMIA AND AS DE NOVO GERMLINE MUTATIONS IN THE SCHINZEL-GIEDION SYNDROME. HERE WE SHOW THAT SETBP1 BINDS TO GDNA IN AT-RICH PROMOTER REGIONS, CAUSING ACTIVATION OF GENE EXPRESSION THROUGH RECRUITMENT OF A HCF1/KMT2A/PHF8 EPIGENETIC COMPLEX. DELETION OF TWO AT-HOOKS ABROGATES THE BINDING OF SETBP1 TO GDNA AND IMPAIRS TARGET GENE UPREGULATION. GENES CONTROLLED BY SETBP1 SUCH AS MECOM ARE SIGNIFICANTLY UPREGULATED IN LEUKEMIAS CONTAINING SETBP1 MUTATIONS. GENE ONTOLOGY ANALYSIS OF DEREGULATED SETBP1 TARGET GENES INDICATES THAT THEY ARE ALSO KEY CONTROLLERS OF VISCERAL ORGAN DEVELOPMENT AND BRAIN MORPHOGENESIS. IN LINE WITH THESE FINDINGS, IN UTERO BRAIN ELECTROPORATION OF MUTATED SETBP1 CAUSES IMPAIRMENT OF MOUSE NEUROGENESIS WITH A PROFOUND DELAY IN NEURONAL MIGRATION. IN SUMMARY, THIS WORK UNVEILS A SETBP1 FUNCTION THAT DIRECTLY AFFECTS GENE TRANSCRIPTION AND CLARIFIES THE MECHANISM OPERATING IN MYELOID MALIGNANCIES AND IN THE SCHINZEL-GIEDION SYNDROME CAUSED BY SETBP1 MUTATIONS. 2018