1 4556 101 MUTATIONAL SPECTRUM OF MYELOID MALIGNANCIES WITH INV(3)/T(3;3) REVEALS A PREDOMINANT INVOLVEMENT OF RAS/RTK SIGNALING PATHWAYS. MYELOID MALIGNANCIES BEARING CHROMOSOMAL INV(3)/T(3;3) ABNORMALITIES ARE AMONG THE MOST THERAPY-RESISTANT LEUKEMIAS. DEREGULATED EXPRESSION OF EVI1 IS THE MOLECULAR HALLMARK OF THIS DISEASE; HOWEVER, THE GENOME-WIDE SPECTRUM OF COOPERATING MUTATIONS IN THIS DISEASE SUBSET HAS NOT BEEN SYSTEMATICALLY ELUCIDATED. HERE, WE SHOW THAT 98% OF INV(3)/T(3;3) MYELOID MALIGNANCIES HARBOR MUTATIONS IN GENES ACTIVATING RAS/RECEPTOR TYROSINE KINASE (RTK) SIGNALING PATHWAYS. IN ADDITION, HEMIZYGOUS MUTATIONS IN GATA2, AS WELL AS HETEROZYGOUS ALTERATIONS IN RUNX1, SF3B1, AND GENES ENCODING EPIGENETIC MODIFIERS, FREQUENTLY CO-OCCUR WITH THE INV(3)/T(3;3) ABERRATION. NOTABLY, NEITHER MUTATIONAL PATTERNS NOR GENE EXPRESSION PROFILES DIFFER ACROSS INV(3)/T(3;3) ACUTE MYELOID LEUKEMIA, CHRONIC MYELOID LEUKEMIA, AND MYELODYSPLASTIC SYNDROME CASES, SUGGESTING RECOGNITION OF INV(3)/T(3;3) MYELOID MALIGNANCIES AS A SINGLE DISEASE ENTITY IRRESPECTIVE OF BLAST COUNT. THE HIGH INCIDENCE OF ACTIVATING RAS/RTK SIGNALING MUTATIONS MAY PROVIDE A TARGET FOR A RATIONAL TREATMENT STRATEGY IN THIS HIGH-RISK PATIENT GROUP. 2015 2 5608 29 RUNX1-EVI1 DISRUPTS LINEAGE DETERMINATION AND THE CELL CYCLE BY INTERFERING WITH RUNX1 AND EVI1 DRIVEN GENE REGULATORY NETWORKS. HEMATOLOGICAL MALIGNANCIES ARE CHARACTERISED BY A BLOCK IN DIFFERENTIATION, WHICH IN MANY CASES IS CAUSED BY RECURRENT MUTATIONS AFFECTING THE ACTIVITY OF HEMATOPOIETIC TRANSCRIPTION FACTORS. RUNX1-EVI1 IS A FUSION PROTEIN FORMED BY THE T(3;21) TRANSLOCATION LINKING TWO TRANSCRIPTION FACTORS REQUIRED FOR NORMAL HEMATOPOIESIS. RUNX1-EVI1 EXPRESSION IS FOUND IN MYELODYSPLASTIC SYNDROME, SECONDARY ACUTE MYELOID LEUKEMIA, AND BLAST CRISIS OF CHRONIC MYELOID LEUKEMIA; WITH CLINICAL OUTCOMES BEING WORSE THAN IN PATIENTS WITH RUNX1-ETO, RUNX1 OR EVI1 MUTATIONS ALONE. RUNX1-EVI1 IS USUALLY FOUND AS A SECONDARY MUTATION, THEREFORE THE MOLECULAR MECHANISMS UNDERLYING HOW RUNX1-EVI1 ALONE CONTRIBUTES TO POOR PROGNOSIS ARE UNKNOWN. TO ADDRESS THIS QUESTION, WE INDUCED EXPRESSION OF RUNX1-EVI1 IN HEMATOPOIETIC CELLS DERIVED FROM AN EMBRYONIC STEM CELL DIFFERENTIATION MODEL. INDUCTION RESULTED IN DISRUPTION OF THE RUNX1-DEPENDENT ENDOTHELIAL-HEMATOPOIETIC TRANSITION, BLOCKED THE CELL CYCLE AND UNDERMINED CELL FATE DECISIONS IN MULTIPOTENT HEMATOPOIETIC PROGENITOR CELLS. INTEGRATIVE ANALYSES OF GENE EXPRESSION WITH CHROMATIN AND TRANSCRIPTION FACTOR BINDING DATA DEMONSTRATED THAT RUNX1-EVI1 BINDING CAUSED THE RE-DISTRIBUTION OF ENDOGENOUS RUNX1 WITHIN THE GENOME AND INTERFERED WITH BOTH RUNX1 AND EVI1 REGULATED GENE EXPRESSION PROGRAMS. IN SUMMARY, RUNX1-EVI1 EXPRESSION ALONE LEADS TO EXTENSIVE EPIGENETIC REPROGRAMMING WHICH IS INCOMPATIBLE WITH HEALTHY BLOOD PRODUCTION. 2021 3 2888 28 GAIN-OF-FUNCTION MUTATION OF GATA-2 IN ACUTE MYELOID TRANSFORMATION OF CHRONIC MYELOID LEUKEMIA. ACQUISITION OF ADDITIONAL GENETIC AND/OR EPIGENETIC ABNORMALITIES OTHER THAN THE BCR/ABL FUSION GENE IS BELIEVED TO CAUSE DISEASE PROGRESSION IN CHRONIC MYELOID LEUKEMIA (CML) FROM CHRONIC PHASE TO BLAST CRISIS (BC). TO GAIN INSIGHTS INTO THE UNDERLYING MECHANISMS OF PROGRESSION TO BC, WE SCREENED DNA SAMPLES FROM CML PATIENTS DURING BLAST TRANSFORMATION FOR MUTATIONS IN A NUMBER OF TRANSCRIPTION FACTOR GENES THAT ARE CRITICAL FOR MYELOID-LYMPHOID DEVELOPMENT. IN 85 CASES OF CML BLAST TRANSFORMATION, WE IDENTIFIED TWO NEW MUTATIONS IN THE CODING REGION OF GATA-2, A NEGATIVE REGULATOR OF HEMATOPOIETIC STEM/PROGENITOR CELL DIFFERENTIATION. A L359V SUBSTITUTION WITHIN ZINC FINGER DOMAIN (ZF) 2 OF GATA-2 WAS FOUND IN EIGHT CASES WITH MYELOMONOBLASTIC FEATURES, WHEREAS AN IN-FRAME DELETION OF 6 AA (DELTA341-346) SPANNING THE C-TERMINAL BORDER OF ZF1 WAS DETECTED IN ONE PATIENT AT MYELOID BC WITH EOSINOPHILIA. FURTHER STUDIES INDICATED THAT L359V NOT ONLY INCREASED TRANSACTIVATION ACTIVITY OF GATA-2 BUT ALSO ENHANCED ITS INHIBITORY EFFECTS ON THE ACTIVITY OF PU.1, A MAJOR REGULATOR OF MYELOPOIESIS. CONSISTENT WITH THE MYELOMONOBLASTIC FEATURES OF CML TRANSFORMATION WITH THE GATA-2 L359V MUTANT, TRANSDUCTION OF THE GATA-2 L359V MUTANT INTO HL-60 CELLS OR BCR/ABL-HARBORING MURINE CELLS DISTURBED MYELOMONOCYTIC DIFFERENTIATION/PROLIFERATION IN VITRO AND IN VIVO, RESPECTIVELY. THESE DATA STRONGLY SUGGEST THAT GATA-2 MUTATIONS MAY PLAY A ROLE IN ACUTE MYELOID TRANSFORMATION IN A SUBSET OF CML PATIENTS. 2008 4 829 31 CHARACTERIZATION OF P190-BCR-ABL CHRONIC MYELOID LEUKEMIA REVEALS SPECIFIC SIGNALING PATHWAYS AND THERAPEUTIC TARGETS. THE ONCOGENIC PROTEIN BCR-ABL HAS TWO MAJOR ISOFORMS, P190(BCR-ABL) AND P210(BCR-ABL). WHILE P210(BCR-ABL) IS THE HALLMARK OF CHRONIC MYELOID LEUKEMIA (CML), P190(BCR-ABL) OCCURS IN THE MAJORITY OF PHILADELPHIA-POSITIVE ACUTE LYMPHOBLASTIC LEUKEMIA (PH + ALL) PATIENTS. IN CML, P190(BCR-ABL) OCCURS IN A MINORITY OF PATIENTS ASSOCIATING WITH DISTINCT HEMATOLOGICAL FEATURES AND INFERIOR OUTCOMES, YET THE PATHOGENIC ROLE OF P190(BCR-ABL) AND POTENTIAL TARGETING THERAPIES ARE LARGELY UNCHARACTERIZED. WE EMPLOYED NEXT GENERATION SEQUENCING, PHOSPHO-PROTEOMIC PROFILING, AND DRUG SENSITIVITY TESTING TO CHARACTERIZE P190(BCR-ABL) IN CML AND HEMATOPOIETIC PROGENITOR CELL LINE MODELS (BA/F3 AND HPC-LSK). P190(BCR-ABL) CML PATIENTS DEMONSTRATED POOR RESPONSE TO IMATINIB AND FREQUENT MUTATIONS IN EPIGENETIC MODIFIERS GENES. IN CONTRAST WITH P210(BCR-ABL), P190(BCR-ABL) EXHIBITED SPECIFIC TRANSCRIPTIONAL UPREGULATION OF INTERFERON, INTERLEUKIN-1 RECEPTOR, AND P53 SIGNALING PATHWAYS, ASSOCIATED WITH HYPERPHOSPHORYLATION OF RELEVANT SIGNALING MOLECULES INCLUDING JAK1/STAT1 AND PAK1 IN ADDITION TO SRC HYPERPHOSPHORYLATION. COMPARABLE TO P190(BCR-ABL) CML PATIENTS, P190(BCR-ABL) CELL LINES DEMONSTRATED SIMILAR TRANSCRIPTIONAL AND PHOSPHO-SIGNALING SIGNATURES. WITH THE DRUG SENSITIVITY SCREENING WE IDENTIFIED TARGETED DRUGS WITH SPECIFIC ACTIVITY IN P190(BCR-ABL) CELL LINES INCLUDING IAP-, PAK1-, AND SRC INHIBITORS AND GLUCOCORTICOIDS. OUR RESULTS PROVIDE NOVEL INSIGHTS INTO THE MECHANISMS UNDERLYING THE DISTINCT FEATURES OF P190(BCR-ABL) CML AND PROMISING THERAPEUTIC TARGETS FOR THIS HIGH-RISK PATIENT GROUP. 2021 5 5775 27 SPERMIDINE/SPERMINE N(1)-ACETYLTRANSFERASE ACTIVITY ASSOCIATES WITH WHITE BLOOD CELL COUNT IN MYELOID LEUKEMIAS. THE METABOLISM OF POLYAMINES, THE CATIONIC SMALL MOLECULES ESSENTIAL FOR CELL PROLIFERATION AND DIFFERENTIATION, IS ALTERED IN CANCER CELLS AND CAN BE EXPLOITED IN CANCER DIAGNOSIS AND THERAPY. SPERMIDINE/SPERMINE N(1)-ACETYLTRANSFERASE (SSAT), WHICH REGULATES INTRACELLULAR LEVELS OF POLYAMINES BY CATABOLIZING SPERMIDINE AND SPERMINE, HAS A CONTROVERSIAL ROLE IN THE DEVELOPMENT OF CANCERS. IN THIS STUDY, THE POLYAMINE METABOLISM AND FUNCTION OF SSAT WERE CHARACTERIZED IN ACUTE MYELOID LEUKEMIA (AML), CHRONIC MYELOID LEUKEMIA (CML), AND ACUTE LYMPHOID LEUKEMIA PATIENT SAMPLES. ALSO, MICE OVEREXPRESSING SSAT AND HAVING A MYELOPROLIFERATIVE PHENOTYPE WERE ANALYZED FOR THEIR RESPONSE TO DECITABINE AND HISTONE DEACETYLASE INHIBITOR TRICHOSTATIN A. THE PRESENCE OF EPIGENETIC FACTORS IN THE BONE MARROW CELLS OF SSAT MICE WAS ANALYZED. ELEVATED LEVELS OF SPERMIDINE AND SPERMINE, AS WELL AS INCREASED ACTIVITY OF SSAT, WERE DETECTED IN AML, CML, AND ACUTE LYMPHOID LEUKEMIA PATIENTS COMPARED WITH THE CONTROLS. HOWEVER, WE FOUND SSAT ACTIVITY TO BE ASSOCIATED WITH WHITE BLOOD CELL COUNT ONLY IN AML AND CML PATIENTS. DECITABINE TREATMENT BROUGHT THE PERIPHERAL BLOOD AND BONE MARROW CELL COUNTS OF SSAT MICE TO THE LEVEL OF WILD-TYPE MICE. SPERMIDINE/SPERMINE N(1)-ACETYLTRANSFERASE MICE HAD INCREASED HISTONE METHYLATION AND AN INCREASED LEVEL OF HISTONE DEACETYLASE 1 IN THEIR BONE MARROW CELLS. THE STUDY SUGGESTS THAT SSAT INFLUENCES THE DEVELOPMENT OF MYELOID MALIGNANCIES, AND EPIGENETIC FACTORS PARTLY CONTRIBUTE TO THE SSAT OVEREXPRESSION-INDUCED MYELOPROLIFERATIVE DISEASE IN MICE. 2014 6 2763 23 EXPRESSION OF THE LEUKEMIC PROGNOSTIC MARKER CD7 IS LINKED TO EPIGENETIC MODIFICATIONS IN CHRONIC MYELOID LEUKEMIA. BACKGROUND: EXPRESSION LEVELS OF THE CELL SURFACE GLYCOPROTEIN, CD7, AND THE SERINE PROTEASE, ELASTASE 2 (ELA2), IN THE LEUKEMIC CELLS OF PATIENTS WITH CHRONIC MYELOID LEUKEMIA (CML) HAVE BEEN ASSOCIATED WITH CLINICAL OUTCOME. HOWEVER, LITTLE IS KNOWN ABOUT THE MECHANISMS THAT UNDERLIE THE VARIABLE EXPRESSION OF THESE GENES IN THE LEUKEMIC CELLS. RESULTS: TO ADDRESS THIS QUESTION, WE COMPARED THE LEVEL OF THEIR EXPRESSION WITH THE DNA METHYLATION AND HISTONE ACETYLATION STATUS OF 5' SEQUENCES OF BOTH GENES IN LEUKEMIC CELL LINES AND PRIMITIVE (LIN-CD34+) LEUKEMIC CELLS FROM CHRONIC PHASE CML PATIENTS. DNA METHYLATION OF THE ELA2 GENE PROMOTER DID NOT CORRELATE WITH ITS EXPRESSION PATTERN IN LIN-CD34+ CELLS FROM CHRONIC PHASE CML PATIENT SAMPLES EVEN THOUGH THERE WAS CLEAR DIFFERENTIAL DNA METHYLATION OF THIS LOCUS IN ELA2-EXPRESSING AND NON-EXPRESSING CELL LINES. IN CONTRAST, WE FOUND A STRONG RELATION BETWEEN CD7 EXPRESSION AND TRANSCRIPTION-PERMISSIVE CHROMATIN MODIFICATIONS, BOTH AT THE LEVEL OF DNA METHYLATION AND HISTONE ACETYLATION WITH EVIDENCE OF HYPOMETHYLATION OF THE CD7 PROMOTER REGION IN THE LIN-CD34+ CELLS FROM CML PATIENTS WITH HIGH CD7 EXPRESSION. CONCLUSION: THESE FINDINGS INDICATE A LINK BETWEEN EPIGENETIC MODIFICATIONS AND CD7 EXPRESSION IN PRIMITIVE CML CELLS. 2010 7 3898 29 LARGE-SCALE TOPOLOGICAL DISRUPTION OF CHROMOSOME TERRITORIES 9 AND 22 IS ASSOCIATED WITH NONRESPONSE TO TREATMENT IN CML. CHRONIC MYELOID LEUKEMIA (CML) IS A MYELOPROLIFERATIVE NEOPLASM DEFINED BY THE PRESENCE OF T(9;22) TRANSLOCATION WHOSE ORIGIN HAS BEEN ASSOCIATED WITH THE TRIDIMENSIONAL GENOME ORGANIZATION. THIS REARRANGEMENT LEADS TO THE FUSION OF BCR AND ABL1 GENES GIVING RISE TO A CHIMERIC PROTEIN WITH CONSTITUTIVE KINASE ACTIVITY. IMATINIB, A TYROSINE KINASE INHIBITOR (TKI), IS USED AS A FIRST-LINE TREATMENT FOR CML, THOUGH ~40% OF CML PATIENTS DO NOT RESPOND. HERE, USING STRUCTURED ILLUMINATION MICROSCOPY (SIM) AND 3D RECONSTRUCTION, WE STUDIED THE 3D ORGANIZATION PATTERNS OF THE ABL1 AND BCR GENES, AND THEIR CHROMOSOME TERRITORIES (CTS) CT9 AND CT22, IN CD34+ CELLS FROM CML PATIENTS THAT RESPONDED OR NOT TO TKI. WE FOUND THAT TKI RESISTANCE IN CML IS ASSOCIATED WITH HIGH LEVELS OF STRUCTURAL DISRUPTION OF CT9 AND CT22 IN CD34+ CELLS, INCREASED CT VOLUMES (ESPECIALLY FOR CT22), INTERMINGLING BETWEEN CT9 AND CT22, AND AN OPEN-CHROMATIN EPIGENETIC MARK IN CT22. ALTOGETHER OUR RESULTS SUGGEST THAT LARGE-SCALE DISRUPTION OF CT9 AND CT22 CORRELATES WITH THE CLINICAL RESPONSE OF CML PATIENTS, WHICH COULD BE TRANSLATED INTO A POTENTIAL PROGNOSTIC MARKER OF RESPONSE TO TREATMENT IN THIS DISEASE AND PROVIDE NOVEL INSIGHTS INTO THE MECHANISMS UNDERLYING RESISTANCE TO TKI IN CML. 2022 8 5934 23 TARGETING FEATURES OF CURAXIN CBL0137 ON HEMATOLOGICAL MALIGNANCIES IN VITRO AND IN VIVO. THE ANTICANCER ACTIVITY OF CURAXIN CBL0137, A DNA-BINDING SMALL MOLECULE WITH CHROMATIN REMODULATING EFFECT, HAS BEEN DEMONSTRATED IN DIFFERENT CANCERS. HEREIN, A COMPARATIVE EVALUATION OF CBL0137 ACTIVITY WAS PERFORMED IN RESPECT TO ACUTE MYELOID LEUKEMIA (AML), ACUTE LYMPHOBLASTIC LEUKEMIA (ALL), CHRONIC MYELOID LEUKEMIA AND MULTIPLE MYELOMA (MM) CULTURED IN VITRO. MTT ASSAY SHOWED AML AND MM HIGHER SENSITIVITY TO CBL0137'S CYTOSTATIC EFFECT COMPARATIVELY TO OTHER HEMATOLOGICAL MALIGNANCY CELLS. FLOW CYTOMETRY CELL CYCLE ANALYSIS REVEALED AN INCREASE IN SUBG1 AND G2/M POPULATIONS AFTER CBL0137 CELL TREATMENT, BUT THE PREVALENT TYPE OF ARREST VARIED. APOPTOSIS ACTIVATION BY CBL0137 MEASURED BY ANNEXIN-V/PI DUAL STAINING WAS MORE ACTIVE IN AML AND MM CELLS. RT2 PCR ARRAY SHOWED THAT CHANGES CAUSED BY CBL0137 IN SIGNALING PATHWAYS INVOLVED IN CANCER PATHOGENESIS WERE MORE INTENSIVE IN AML AND MM CELLS. ON THE MURINE MODEL OF AML WEHI-3, CBL0137 SHOWED SIGNIFICANT ANTICANCER EFFECTS IN VIVO, WHICH WERE EVALUATED BY CORRESPONDING CHANGES IN SPLEEN AND LIVER. THUS, MORE PRONOUNCED ANTICANCER EFFECTS OF CBL0137 IN VITRO WERE OBSERVED IN RESPECT TO AML AND MM. EXPERIMENTS IN VIVO ALSO INDICATED THE PERSPECTIVE OF CBL0137 USE FOR AML TREATMENT. THIS IN ACCORDANCE WITH THE FRONTLINE TREATMENT APPROACH IN AML USING EPIGENETIC DRUGS. 2023 9 1629 23 DNMT3A ARG882 MUTATION DRIVES CHRONIC MYELOMONOCYTIC LEUKEMIA THROUGH DISTURBING GENE EXPRESSION/DNA METHYLATION IN HEMATOPOIETIC CELLS. THE GENE ENCODING DNA METHYLTRANSFERASE 3A (DNMT3A) IS MUTATED IN APPROXIMATELY 20% OF ACUTE MYELOID LEUKEMIA CASES, WITH ARG882 (R882) AS THE HOTSPOT. HERE, WE ADDRESSED THE TRANSFORMATION ABILITY OF THE DNMT3A-ARG882HIS (R882H) MUTANT BY USING A RETROVIRAL TRANSDUCTION AND BONE MARROW TRANSPLANTATION (BMT) APPROACH AND FOUND THAT THE MUTANT GENE CAN INDUCE ABERRANT PROLIFERATION OF HEMATOPOIETIC STEM/PROGENITOR CELLS. AT 12 MO POST-BMT, ALL MICE DEVELOPED CHRONIC MYELOMONOCYTIC LEUKEMIA WITH THROMBOCYTOSIS. RNA MICROARRAY ANALYSIS REVEALED ABNORMAL EXPRESSIONS OF SOME HEMATOPOIESIS-RELATED GENES, AND THE DNA METHYLATION ASSAY IDENTIFIED CORRESPONDING CHANGES IN METHYLATION PATTERNS IN GENE BODY REGIONS. MOREOVER, DNMT3A-R882H INCREASED THE CDK1 PROTEIN LEVEL AND ENHANCED CELL-CYCLE ACTIVITY, THEREBY CONTRIBUTING TO LEUKEMOGENESIS. 2014 10 3009 30 GENETICS AND EPIGENETICS IN NEOPLASMS WITH PLASMACYTOID DENDRITIC CELLS. PLASMACYTOID DENDRITIC CELLS (PDC) ARE TYPE I INTERFERON (IFN)-PRODUCING CELLS THAT PLAY A KEY ROLE IN IMMUNE RESPONSES. TWO MAJOR TYPES OF NEOPLASTIC COUNTERPARTS FOR PDC ARE NOW DISCRIMINATED: BLASTIC PDC NEOPLASM (BPDCN) AND MATURE PDC PROLIFERATION (MPDCP), ASSOCIATED WITH MYELOID NEOPLASM. TWO TYPES OF MPDCP ARE NOW BETTER DESCRIBED: CHRONIC MYELOMONOCYTIC LEUKEMIA WITH PDC EXPANSION (PDC-CMML) AND ACUTE MYELOID LEUKEMIA WITH PDC EXPANSION (PDC-AML). DIFFERENTIAL DIAGNOSIS BETWEEN PDC-AML AND BPDCN IS PARTICULARLY CHALLENGING, AND GENOMIC FEATURES CAN HELP FOR DIAGNOSIS. HERE, WE SYSTEMATICALLY REVIEW THE CYTOGENETIC, MOLECULAR, AND TRANSCRIPTIONAL CHARACTERISTICS OF BPDCN AND PDC-AML. BPDCN ARE CHARACTERIZED BY FREQUENT COMPLEX KARYOTYPES WITH RECURRENT MYB/MYC REARRANGEMENTS AS WELL AS RECURRENT DELETIONS INVOLVING ETV6, IKZF1, RB1, AND TP53 LOCI. EPIGENETIC AND SPLICING PATHWAYS ARE ALSO PARTICULARLY MUTATED, WHILE ORIGINAL PROCESSES ARE DYSREGULATED, SUCH AS NF-KB, TCF4, BCL2, AND IFN PATHWAYS; NEUTROPHIL-SPECIFIC RECEPTORS; AND CHOLINERGIC SIGNALING. IN CONTRAST, CYTOGENETIC ABNORMALITIES ARE LIMITED IN PDC-AML AND ARE QUITE SIMILAR TO OTHER AML. INTERESTINGLY, RUNX1 IS THE MOST FREQUENTLY MUTATED GENE (70% OF CASES). THESE TYPICAL GENOMIC FEATURES ARE OF POTENTIAL INTEREST FOR DIAGNOSIS, AND ALSO FROM A PROGNOSTIC OR THERAPEUTIC PERSPECTIVE. 2022 11 5101 24 POLYCOMB FACTOR PHF19 CONTROLS CELL GROWTH AND DIFFERENTIATION TOWARD ERYTHROID PATHWAY IN CHRONIC MYELOID LEUKEMIA CELLS. POLYCOMB GROUP (PCG) OF PROTEINS ARE A GROUP OF HIGHLY CONSERVED EPIGENETIC REGULATORS INVOLVED IN MANY BIOLOGICAL FUNCTIONS, SUCH AS EMBRYONIC DEVELOPMENT, CELL PROLIFERATION, AND ADULT STEM CELL DETERMINATION. PHD FINGER PROTEIN 19 (PHF19) IS AN ASSOCIATED FACTOR OF POLYCOMB REPRESSOR COMPLEX 2 (PRC2), OFTEN UPREGULATED IN HUMAN CANCERS. IN PARTICULAR, MYELOID LEUKEMIA CELL LINES SHOW INCREASED LEVELS OF PHF19, YET LITTLE IS KNOWN ABOUT ITS FUNCTION. HERE, WE HAVE CHARACTERIZED THE ROLE OF PHF19 IN MYELOID LEUKEMIA CELLS. WE DEMONSTRATED THAT PHF19 DEPLETION DECREASES CELL PROLIFERATION AND PROMOTES CHRONIC MYELOID LEUKEMIA (CML) DIFFERENTIATION. MECHANISTICALLY, WE HAVE SHOWN HOW PHF19 REGULATES THE PROLIFERATION OF CML THROUGH A DIRECT REGULATION OF THE CELL CYCLE INHIBITOR P21. FURTHERMORE, WE OBSERVED THAT MTF2, A PHF19 HOMOLOG, PARTIALLY COMPENSATES FOR PHF19 DEPLETION IN A SUBSET OF TARGET GENES, INSTRUCTING SPECIFIC ERYTHROID DIFFERENTIATION. TAKEN TOGETHER, OUR RESULTS SHOW THAT PHF19 IS A KEY TRANSCRIPTIONAL REGULATOR FOR CELL FATE DETERMINATION AND COULD BE A POTENTIAL THERAPEUTIC TARGET FOR MYELOID LEUKEMIA TREATMENT. 2021 12 3484 29 IDENTIFICATION OF CHROMATIN REMODELING GENES ARID4A AND ARID4B AS LEUKEMIA SUPPRESSOR GENES. BACKGROUND: LEUKEMIA EVOLVES THROUGH A MULTISTEP PROCESS FROM PREMALIGNANCY TO MALIGNANCY. EPIGENETIC ALTERATIONS, INCLUDING HISTONE MODIFICATIONS, HAVE BEEN PROPOSED TO PLAY AN IMPORTANT ROLE IN TUMORIGENESIS. THE INVOLVEMENT OF TWO CHROMATIN REMODELING GENES, RETINOBLASTOMA-BINDING PROTEIN 1 (RBBP1/ARID4A) AND RBBP1-LIKE 1 (RBBP1L1/ARID4B), IN LEUKEMOGENESIS WAS NOT CHARACTERIZED. METHODS: THE LEUKEMIC PHENOTYPE OF MICE DEFICIENT FOR ARID4A WITH OR WITHOUT HAPLOINSUFFICIENCY FOR ARID4B WAS INVESTIGATED BY SERIALLY MONITORING COMPLETE BLOOD COUNTS TOGETHER WITH MICROSCOPIC HISTOLOGIC ANALYSIS AND FLOW CYTOMETRIC ANALYSIS OF BONE MARROW AND SPLEEN FROM THE ARID4A(-/-) MICE OR ARID4A(-/-)ARID4B(+/-) MICE. REGULATION IN BONE MARROW CELLS OF DOWNSTREAM GENES IMPORTANT FOR NORMAL HEMATOPOIESIS WAS ANALYZED BY REVERSE TRANSCRIPTION-POLYMERASE CHAIN REACTION. GENOTYPIC EFFECTS ON HISTONE MODIFICATIONS WERE EXAMINED BY WESTERN BLOTTING AND IMMUNOFLUORESCENCE ANALYSIS. ALL STATISTICAL TESTS WERE TWO-SIDED. RESULTS: YOUNG (2-5 MONTHS OLD) ARID4A-DEFICIENT MICE HAD INEFFECTIVE BLOOD CELL PRODUCTION IN ALL HEMATOPOIETIC LINEAGES. BEYOND 5 MONTHS OF AGE, THE ARID4A(-/-) MICE MANIFESTED MONOCYTOSIS, ACCOMPANIED BY SEVERE ANEMIA AND THROMBOCYTOPENIA. THESE SICK ARID4A(-/-) MICE SHOWED BONE MARROW FAILURE WITH MYELOFIBROSIS ASSOCIATED WITH SPLENOMEGALY AND HEPATOMEGALY. FIVE OF 42 ARID4A(-/-) MICE AND 10 OF 12 ARID4A(-/-)ARID4B(+/-) MICE PROGRESSED TO ACUTE MYELOID LEUKEMIA (AML) AND HAD RAPID FURTHER INCREASES OF LEUKOCYTE COUNTS. EXPRESSION OF HOX GENES (HOXB3, HOXB5, HOXB6, AND HOXB8) WAS DECREASED IN ARID4A-DEFICIENT BONE MARROW CELLS WITH OR WITHOUT ARID4B HAPLOINSUFFICIENCY, AND FOXP3 EXPRESSION WAS REDUCED IN ARID4A(-/-)ARID4B(+/-) BONE MARROW. INCREASES OF HISTONE TRIMETHYLATION OF H3K4, H3K9, AND H4K20 (FOLD INCREASES IN TRIMETHYLATION = 32, 95% CONFIDENCE INTERVAL [CI] = 27 TO 32; 45, 95% CI = 41 TO 49; AND 2.2, 95% CI = 1.7 TO 2.7, RESPECTIVELY) WERE OBSERVED IN THE BONE MARROW OF ARID4A-DEFICIENT MICE. CONCLUSIONS: ARID4A-DEFICIENT MICE INITIALLY DISPLAY INEFFECTIVE HEMATOPOIESIS, FOLLOWED BY TRANSITION TO CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML)-LIKE MYELODYSPLASTIC/MYELOPROLIFERATIVE DISORDER, AND THEN TRANSFORMATION TO AML. THE DISEASE PROCESSES IN THE ARID4A-DEFICIENT MICE ARE VERY SIMILAR TO THE COURSE OF EVENTS IN HUMANS WITH CMML AND AML. THIS MOUSE MODEL HAS THE POTENTIAL TO FURNISH ADDITIONAL INSIGHTS INTO THE ROLE OF EPIGENETIC ALTERATIONS IN LEUKEMOGENESIS, AND IT MAY BE USEFUL IN DEVELOPING NOVEL PHARMACOLOGICAL APPROACHES TO TREATMENT OF PRELEUKEMIC AND LEUKEMIC STATES. 2008 13 3756 28 INTEGRATED GENOMIC SEQUENCING IN MYELOID BLAST CRISIS CHRONIC MYELOID LEUKEMIA (MBC-CML), IDENTIFIED POTENTIALLY IMPORTANT FINDINGS IN THE CONTEXT OF LEUKEMOGENESIS MODEL. CHRONIC MYELOID LEUKEMIA (CML) IS A MODEL OF LEUKEMOGENESIS IN WHICH THE EXACT MOLECULAR MECHANISMS UNDERLYING BLAST CRISIS STILL REMAINED UNEXPLORED. THE CURRENT STUDY IDENTIFIED MULTIPLE COMMON AND RARE IMPORTANT FINDINGS IN MYELOID BLAST CRISIS CML (MBC-CML) USING INTEGRATED GENOMIC SEQUENCING, COVERING ALL CLASSES OF GENES IMPLICATED IN THE LEUKEMOGENESIS MODEL. INTEGRATED GENOMIC SEQUENCING VIA WHOLE EXOME SEQUENCING (WES), CHROMOSOME-SEQ AND RNA-SEQUENCING WERE CONDUCTED ON THE PERIPHERAL BLOOD SAMPLES OF THREE CML PATIENTS IN THE MYELOID BLAST CRISIS. AN IN-HOUSE FILTERING PIPELINE WAS APPLIED TO ASSESS IMPORTANT VARIANTS IN CANCER-RELATED GENES. STANDARD VARIANT INTERPRETATION GUIDELINES WERE USED FOR THE INTERPRETATION OF POTENTIALLY IMPORTANT FINDINGS (PIFS) AND POTENTIALLY ACTIONABLE FINDINGS (PAFS). SINGLE NUCLEOTIDE VARIATION (SNV) AND SMALL INDEL ANALYSIS BY WES DETECTED SIXTEEN PIFS AFFECTING ALL FIVE KNOWN CLASSES OF LEUKEMOGENIC GENES IN MYELOID MALIGNANCIES INCLUDING SIGNALING PATHWAY COMPONENTS (ABL1, PIK3CB, PTPN11), TRANSCRIPTION FACTORS (GATA2, PHF6, IKZF1, WT1), EPIGENETIC REGULATORS (ASXL1), TUMOR SUPPRESSOR AND DNA REPAIR GENES (BRCA2, ATM, CHEK2) AND COMPONENTS OF SPLICEOSOME (PRPF8). THESE VARIANTS AFFECT GENES INVOLVED IN LEUKEMIA STEM CELL PROLIFERATION, SELF-RENEWAL, AND DIFFERENTIATION. BOTH PATIENTS NO.1 AND NO.2 HAD ACTIONABLE KNOWN MISSENSE VARIANTS ON ABL1 (P.Y272H, P.F359V) AND FRAMESHIFT VARIANTS ON ASXL1 (P.A627GFS*8, P.G646WFS*12). THE GATA2-L359S IN PATIENT NO.1, PTPN11-G503V AND IKZF1-R208Q VARIANTS IN THE PATIENT NO.3 WERE ALSO PAFS. RNA-SEQUENCING WAS USED TO CONFIRM ALL OF THE IDENTIFIED VARIANTS. IN THE PATIENT NO. 3, CHROMOSOME SEQUENCING REVEALED MULTIPLE PATHOGENIC DELETIONS IN THE SHORT AND LONG ARMS OF CHROMOSOME 7, AFFECTING AT LEAST THREE CRITICAL LEUKEMOGENIC GENES (IKZF1, EZH2, AND CUX1). THE LARGE DELETION DISCOVERED ON THE SHORT ARM OF CHROMOSOME 17 IN PATIENT NO. 2 RESULTED IN THE DELETION OF TP53 GENE AS WELL. INTEGRATED GENOMIC SEQUENCING COMBINED WITH RNA-SEQUENCING CAN SUCCESSFULLY DISCOVER AND CONFIRM A WIDE RANGE OF VARIANTS, FROM SNVS TO CNVS. THIS STRATEGY MAY BE AN EFFECTIVE METHOD FOR IDENTIFYING ACTIONABLE FINDINGS AND UNDERSTANDING THE PATHOPHYSIOLOGICAL MECHANISMS UNDERLYING MBC-CML, AS WELL AS PROVIDING FURTHER INSIGHTS INTO THE GENETIC BASIS OF MBC-CML AND ITS MANAGEMENT IN THE FUTURE. 2022 14 1334 23 DEREGULATION OF AIOLOS EXPRESSION IN CHRONIC LYMPHOCYTIC LEUKEMIA IS ASSOCIATED WITH EPIGENETIC MODIFICATIONS. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS CHARACTERIZED BY A CLONAL ACCUMULATION OF MATURE NEOPLASTIC B CELLS THAT ARE RESISTANT TO APOPTOSIS. AIOLOS, A MEMBER OF THE IKAROS FAMILY OF ZINC-FINGER TRANSCRIPTION FACTORS, PLAYS AN IMPORTANT ROLE IN THE CONTROL OF MATURE B LYMPHOCYTE DIFFERENTIATION AND MATURATION. IN THIS STUDY, WE SHOWED THAT AIOLOS EXPRESSION IS UP-REGULATED IN B-CLL CELLS. THIS OVEREXPRESSION DOES NOT IMPLICATE ISOFORM IMBALANCE OR DISTURB AIOLOS SUBCELLULAR LOCALIZATION. THE CHROMATIN STATUS AT THE AIOLOS PROMOTER IN CLL IS DEFINED BY THE DEMETHYLATION OF DNA AND AN ENRICHMENT OF EUCHROMATIN ASSOCIATED HISTONE MARKERS, SUCH AS THE DIMETHYLATION OF THE LYSINE 4 ON HISTONE H3. THESE EPIGENETIC MODIFICATIONS SHOULD ALLOW ITS UPSTREAM EFFECTORS, SUCH AS NUCLEAR FACTOR-KAPPAB, CONSTITUTIVELY ACTIVATED IN CLL, TO GAIN ACCESS TO PROMOTER, RESULTING UP-REGULATION OF AIOLOS. TO DETERMINE THE CONSEQUENCES OF AIOLOS DEREGULATION IN CLL, WE ANALYZED THE EFFECTS OF AIOLOS OVEREXPRESSION OR DOWN-REGULATION ON APOPTOSIS. AIOLOS IS INVOLVED IN CELL SURVIVAL BY REGULATING THE EXPRESSION OF SOME BCL-2 FAMILY MEMBERS. OUR RESULTS STRONGLY SUGGEST THAT AIOLOS DEREGULATION BY EPIGENETIC MODIFICATIONS MAY BE A HALLMARK OF CLL. 2011 15 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 16 62 24 A HIGH DEFINITION PICTURE OF SOMATIC MUTATIONS IN CHRONIC LYMPHOPROLIFERATIVE DISORDER OF NATURAL KILLER CELLS. THE MOLECULAR PATHOGENESIS OF CHRONIC LYMPHOPROLIFERATIVE DISORDER OF NATURAL KILLER (NK) CELLS (CLPD-NK) IS POORLY UNDERSTOOD. FOLLOWING THE SCREENING OF 57 CLPD-NK PATIENTS, ONLY FIVE PRESENTED STAT3 MUTATIONS. WES PROFILING OF 13 CASES NEGATIVE FOR STAT3/STAT5B MUTATIONS UNCOVERED AN AVERAGE OF 18 CLONAL, POPULATION RARE AND DELETERIOUS SOMATIC VARIANTS PER PATIENT. THE MUTATIONAL LANDSCAPE OF CLPD-NK SHOWED THAT MOST PATIENTS CARRY A HEAVY MUTATIONAL BURDEN, WITH MAJOR AND SUBCLONAL DELETERIOUS MUTATIONS CO-EXISTING IN THE LEUKEMIC CLONE. SOMATIC MUTATIONS HIT GENES WIRED TO CANCER PROLIFERATION, SURVIVAL, AND MIGRATION PATHWAYS, IN THE FIRST PLACE RAS/MAPK, PI3K-AKT, IN ADDITION TO JAK/STAT (PIK3R1 AND PTK2). WE CONFIRMED VARIANTS WITH PUTATIVE DRIVER ROLE OF MAP10, MPZL1, RPS6KA1, SETD1B, TAOK2, TMEM127, AND TNFRSF1A GENES, AND OF GENES LINKED TO VIRAL INFECTIONS (DDX3X AND RSF1) AND DNA REPAIR (PAXIP1). A TRUNCATING MUTATION OF THE EPIGENETIC REGULATOR TET2 AND A VARIANT LIKELY ABROGATING PIK3R1-NEGATIVE REGULATORY ACTIVITY WERE VALIDATED. THIS STUDY SIGNIFICANTLY FURTHERED THE VIEW OF THE GENES AND PATHWAYS INVOLVED IN CLPD-NK, INDICATED SIMILARITIES WITH AGGRESSIVE DISEASES OF NK CELLS AND DETECTED MUTATED GENES TARGETABLE BY APPROVED DRUGS, BEING A STEP FORWARD TO PERSONALIZED PRECISION MEDICINE FOR CLPD-NK PATIENTS. 2020 17 2088 34 EPIGENETIC DYSREGULATION OF SECRETED FRIZZLED-RELATED PROTEINS IN MYELOPROLIFERATIVE NEOPLASMS COMPLEMENTS THE JAK2V617F-MUTATION. BACKGROUND: SECRETED FRIZZLED-RELATED PROTEINS (SFRPS) ARE ANTAGONISTS OF THE WNT SIGNALING PATHWAY, WHICH PLAYS A CENTRAL ROLE IN STEM CELL MAINTENANCE AND DIFFERENTIATION OF STEM CELLS AND HEMATOPOIETIC PROGENITORS. EPIGENETIC DOWNREGULATION OF SFRPS BY PROMOTER HYPERMETHYLATION HAS BEEN DESCRIBED TO BE INVOLVED IN THE PATHOGENESIS OF HEMATOPOIETIC MALIGNANCIES. THERE IS AN ASSOCIATION BETWEEN ABERRANT WNT SIGNALING AND THE ESTABLISHED CANCER STEM CELL CONCEPT. IN CONTRAST TO BCR-ABL1-POSITIVE CHRONIC MYELOID LEUKEMIA CML, BCR-ABL1-NEGATIVE MYELOPROLIFERATIVE NEOPLASMS (PH-MPN) ARE CHARACTERIZED BY THE FREQUENT OCCURRENCE OF AN AUTOACTIVATING MUTATION IN THE JAK2 TYROSINE KINASE (JAK2V617F) OR OTHER MUTATIONS IN THE JAK-STAT PATHWAY. HOWEVER, PATHOGENETIC MECHANISMS OF JAK2 MUTATED OR UNMUTATED PH-MPN REMAIN NOT COMPLETELY UNDERSTOOD. WE DETERMINED THE PROMOTER METHYLATION STATUS OF SFRP-1, -2, -4, AND -5 IN 57 MPN PATIENT SAMPLES BY METHYLATION-SPECIFIC POLYMERASE CHAIN REACTION (PCR) (MSP). JAK2V617F WAS ASSESSED BY ALLELE-SPECIFIC PCR. RESULTS: ABERRANT METHYLATION AMONG PRIMARY MPN SAMPLES WAS 4% FOR SFRP-1, 25% FOR SFRP-2, 2% FOR SFRP-4, AND 0% FOR SFRP-5. HYPERMETHYLATION OF SFRP-2, WHICH WAS THE MOST FREQUENTLY HYPERMETHYLATED GENE IN OUR STUDY, COULD NOT BE CORRELATED TO ANY SPECIFIC MPN SUBTYPE. HOWEVER, WE DETECTED A SIGNIFICANT CORRELATION BETWEEN SFRP-2 METHYLATION AND PRESENCE OF A JAK2V617F MUTATION (P = 0.008). NONE OF THE 10 CML SAMPLES SHOWED ANY SFRP-METHYLATION. CONCLUSIONS: OUR DATA INDICATE THAT EPIGENETIC DYSREGULATION OF THE WNT SIGNALING PATHWAY IS A COMMON EVENT IN MPN WITH ABERRANT METHYLATION OF AT LEAST ONE SFRP BEING DETECTED IN 25% OF THE PRIMARY PATIENT SAMPLES AND IN 30% IF ONLY ACCOUNTING FOR PH-MPN. A SIGNIFICANT CORRELATION BETWEEN SFRP-2 METHYLATION AND PRESENCE OF JAK2V617F IN OUR DATA SUPPORTS THE HYPOTHESIS THAT EPIGENETIC DYSREGULATION MAY BE A COMPLEMENTARY MECHANISM TO GENETIC ABERRATIONS. ABERRANT METHYLATION OF CRUCIAL STEM CELL MAINTENANCE GENES SEEMS TO CONTRIBUTE TO DISEASE PATHOGENESIS IN PH-MPN. 2012 18 671 29 BOTHROPS MOOJENI L-AMINO ACID OXIDASE INDUCES APOPTOSIS AND EPIGENETIC MODULATION ON BCR-ABL(+) CELLS. BACKGROUND: RESISTANCE TO APOPTOSIS IN CHRONIC MYELOID LEUKEMIA (CML) IS ASSOCIATED WITH CONSTITUTIVE TYROSINE KINASE ACTIVITY OF THE BCR-ABL ONCOPROTEIN. THE DEREGULATED EXPRESSION OF APOPTOSIS-RELATED GENES AND ALTERATION IN EPIGENETIC MACHINERY MAY ALSO CONTRIBUTE TO APOPTOSIS RESISTANCE IN CML. TYROSINE KINASE INHIBITORS TARGET THE BCR-ABL ONCOPROTEIN AND ARE USED IN CML TREATMENT. THE RESISTANCE OF CML PATIENTS TO TYROSINE KINASE INHIBITORS HAS GUIDED THE SEARCH FOR NEW COMPOUNDS THAT MAY INDUCE APOPTOSIS IN BCR-ABL(+) LEUKEMIC CELLS AND IMPROVE THE DISEASE TREATMENT. METHODS: IN THE PRESENT STUDY, WE INVESTIGATED WHETHER THE L-AMINO ACID OXIDASE ISOLATED FROM BOTHROPS MOOJENI SNAKE VENOM (BMOOLAAO-I) (I) WAS CYTOTOXIC TO BCR-ABL(+) CELL LINES (HL-60.BCR-ABL, K562-S, AND K562-R), HL-60 (ACUTE PROMYELOCYTIC LEUKEMIA) CELLS, THE NON-TUMOR CELL LINE HEK-293, AND PERIPHERAL BLOOD MONONUCLEAR CELLS (PBMC); AND (II) AFFECTED EPIGENETIC MECHANISMS, INCLUDING DNA METHYLATION AND MICRORNAS EXPRESSION IN VITRO. RESULTS: BMOOLAAO-I INDUCED ROS PRODUCTION, APOPTOSIS, AND DIFFERENTIAL DNA METHYLATION PATTERN OF REGULATORY APOPTOSIS GENES. THE TOXIN UPREGULATED EXPRESSION OF THE PRO-APOPTOTIC GENES BID AND FADD AND DOWNREGULATED DFFA EXPRESSION IN LEUKEMIC CELL LINES, AS WELL AS INCREASED MIR-16 EXPRESSION - WHOSE MAJOR PREDICTED TARGET IS THE ANTI-APOPTOTIC GENE BCL2 - IN BCR-ABL(+) CELLS. CONCLUSION: BMOOLAAO-I EXERTS SELECTIVE ANTITUMOR ACTION MEDIATED BY H(2)O(2) RELEASE AND INDUCES APOPTOSIS, AND ALTERATIONS IN EPIGENETIC MECHANISMS. THESE RESULTS SUPPORT FUTURE INVESTIGATIONS ON THE EFFECT OF BMOOLAAO-I ON IN VIVO MODELS TO DETERMINE ITS POTENTIAL IN CML THERAPY. 2020 19 3500 28 IDENTIFICATION OF NOVEL, CLONALLY STABLE, SOMATIC MUTATIONS TARGETING TRANSCRIPTION FACTORS PAX5 AND NKX2-3, THE EPIGENETIC REGULATOR LRIF1, AND BRAF IN A CASE OF ATYPICAL B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA HARBORING A T(14;18)(Q32;Q21). DIAGNOSIS OF B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA (B-CLL) IS USUALLY STRAIGHTFORWARD, INVOLVING CLINICAL, IMMUNOPHENOTYPIC (MATUTES SCORE), AND (IMMUNO)GENETIC ANALYSES (TO REFINE PATIENT PROGNOSIS FOR TREATMENT). CLL CASES WITH ATYPICAL PRESENTATION (E.G., MATUTES