1 5512 101 RICHTER SYNDROME IN CHRONIC LYMPHOCYTIC LEUKEMIA: UPDATES ON BIOLOGY, CLINICAL FEATURES AND THERAPY. RICHTER SYNDROME (RS) OR RICHTER TRANSFORMATION IS THE DEVELOPMENT OF SECONDARY AGGRESSIVE LYMPHOMA IN THE SETTING OF UNDERLYING CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA (CLL/SLL). MOST FREQUENTLY CLL TRANSFORMS INTO DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) (90%) AND RARELY (10%) INTO HODGKIN LYMPHOMA, TERMED HODGKIN VARIANT OF RICHTER SYNDROME (HVRS). RS IS GENERALLY CHARACTERIZED BY AN AGGRESSIVE CLINICAL COURSE AND POOR PROGNOSIS. IN RECENT YEARS, MAJOR ADVANCES HAVE BEEN MADE IN UNDERSTANDING GENETIC EVENTS WHICH RELATE TO THE PROGRESSION OF CLL OR TRANSFORMATION INTO RS. BETTER UNDERSTANDING OF THE MOLECULAR PATHWAYS HAS REVEALED THAT RS IS NOT A SINGLE HOMOGENEOUS ENTITY. THE MAJORITY OF CASES ARE CLONALLY RELATED TO THE ORIGINAL CLL CLONE, WHILE A MINORITY DEVELOP FROM AN UNRELATED CLONE. THIS REVIEW SUMMARIZES NEW DATA RELATING TO THE MOLECULAR BIOLOGY AND THE GENETIC/EPIGENETIC CHANGES OCCURRING DURING RICHTER TRANSFORMATION, AND ALSO CONSIDERS THE CLINICAL FEATURES AND THERAPY FOR BOTH DLBCL-RS AND HODGKIN VARIANT-RS. 2015 2 867 25 CHRONIC ACTIVE EPSTEIN-BARR VIRUS INFECTION OF T/NK-CELL TYPE MIMICKING CLASSIC HODGKIN LYMPHOMA: CLINICOPATHOLOGIC AND GENETIC FEATURES OF 8 CASES SUPPORTING A VARIANT WITH "HODGKIN/REED-STERNBERG-LIKE" CELLS OF NK PHENOTYPE. CHRONIC ACTIVE EPSTEIN-BARR VIRUS (EBV) INFECTION OF T-CELL AND NK-CELL TYPE, SYSTEMIC FORM (CAEBV-T/NK-S) IS CHARACTERIZED BY EBV T-CELL AND/OR NK-CELL PROLIFERATION WITH NO CHANGES SUGGESTING MALIGNANCY. THEREFORE, WHEN HODGKIN/REED-STERNBERG (HRS)-LIKE CELLS ARE SCATTERED IN CAEBV-T/NK-S, IT IS MORE LIKELY TO BE MISDIAGNOSED AS CLASSIC HODGKIN LYMPHOMA. WE ENCOUNTERED A CASE WHEREIN THE PATIENT SHOWED HRS-LIKE CELLS WITH TYPICAL NK PHENOTYPE. THEREFORE, WE FURTHER INVESTIGATED 8 SIMILAR CASES TO PROVIDE CLINICOPATHOLOGIC AND GENETIC FEATURES AND DISCUSS THEIR DISTINCTION FROM OTHER RELATED DISEASES. CLINICALLY, ALL CASES MET THE DIAGNOSTIC CRITERIA OF CAEBV. MOREOVER, 4/8 PATIENTS HAD HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS. THE MEDIAN SURVIVAL WAS 16 MONTHS (RANGE, 5 TO 35 MO). PATHOLOGICALLY, ALL LYMPH NODE SAMPLES HAD A REMARKABLY SIMILAR MORPHOLOGY WITH SCATTERED HRS-LIKE CELLS SURROUNDED BY A MIXTURE OF SMALL-SIZED LYMPHOCYTES, PLASMA CELLS, AND MACROPHAGES THAT MASQUERADED CLASSIC HODGKIN LYMPHOMA. BESIDES, ERYTHROPHAGOCYTOSIS WAS DETECTED IN 4/11 SAMPLES. THE HRS-LIKE CELLS WERE POSITIVE FOR CD2, CD3P, CD30, CD56, GRB, AND EBER-ISH, BUT NEGATIVE FOR CD20, CD5, PAX-5, AND LMP-1. THE SURROUNDING LYMPHOCYTES WERE MAINLY CD8 CYTOTOXIC T CELLS, WITHOUT OBVIOUS ABERRANT EXPRESSION. IN ADDITION, ALL PATIENTS WERE POLYCLONAL IN THE T-CELL RECEPTOR GAMMA REARRANGEMENT TEST. THE HARBORED MUTATIONS WERE MAINLY IN EPIGENETIC MODIFIERS, JAK-STAT SIGNALING PATHWAY, AND APOPTOSIS/CELL CYCLE PATHWAY, INCLUDING SOCS1, DDX3X, AND KMT2D, SIMILAR TO OTHER EBV-ASSOCIATED T/NK-CELL LYMPHOPROLIFERATIVE DISORDERS. THEREFORE, THE EVIDENCE INDICATES THAT "HRS-LIKE CELLS OF NK PHENOTYPE" IS A VARIANT OF CAEBV-T/NK-S. THIS STUDY MAY RAISE AWARENESS OF SUCH CONFOUNDING CAEBV-T/N-S CASES IN CLINICAL PRACTICE TO AVOID MISDIAGNOSIS AND TREATMENT DELAY. 2019 3 4432 33 MOLECULAR CHARACTERIZATION OF RICHTER SYNDROME IDENTIFIES DE NOVO DIFFUSE LARGE B-CELL LYMPHOMAS WITH POOR PROGNOSIS. RICHTER SYNDROME (RS) IS THE TRANSFORMATION OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) INTO AGGRESSIVE LYMPHOMA, MOST COMMONLY DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL). WE CHARACTERIZE 58 PRIMARY HUMAN RS SAMPLES BY GENOME-WIDE DNA METHYLATION AND WHOLE-TRANSCRIPTOME PROFILING. OUR COMPREHENSIVE APPROACH DETERMINES RS DNA METHYLATION PROFILE AND UNRAVELS A CLL EPIGENETIC IMPRINT, ALLOWING CLL-RS CLONAL RELATIONSHIP ASSESSMENT WITHOUT THE NEED OF THE INITIAL CLL TUMOR DNA. DNA METHYLATION- AND TRANSCRIPTOMIC-BASED CLASSIFIERS WERE DEVELOPED, AND TESTING ON LANDMARK DLBCL DATASETS IDENTIFIES A POOR-PROGNOSIS, ACTIVATED B-CELL-LIKE DLBCL SUBSET IN 111/1772 SAMPLES. THE CLASSIFICATION ROBUSTLY IDENTIFIES PHENOTYPES VERY SIMILAR TO RS WITH A SPECIFIC GENOMIC PROFILE, ACCOUNTING FOR 4.3-8.3% OF DE NOVO DLBCLS. IN THIS WORK, RS MULTI-OMICS CHARACTERIZATION DETERMINES ONCOGENIC MECHANISMS, ESTABLISHES A SURROGATE MARKER FOR CLL-RS CLONAL RELATIONSHIP, AND PROVIDES A CLINICALLY RELEVANT CLASSIFIER FOR A SUBSET OF PRIMARY "RS-TYPE DLBCL" WITH UNFAVORABLE PROGNOSIS. 2023 4 1775 31 EBV IN T-/NK-CELL TUMORIGENESIS. EPSTEIN-BARR VIRUS (EBV), WHICH IS ASSOCIATED WITH B-CELL PROLIFERATIVE DISORDERS, ALSO TRANSFORMS T- OR NATURAL KILLER (NK)-LINEAGE CELLS AND HAS BEEN CONNECTED WITH VARIOUS T- OR NK (T/NK)-CELL MALIGNANCIES, SUCH AS EXTRANODAL NK/T-CELL LYMPHOMA-NASAL TYPE AND AGGRESSIVE NK-CELL LEUKEMIA. CHRONIC ACTIVE EBV (CAEBV) DISEASE , WHICH OCCURS MOST OFTEN IN CHILDREN AND YOUNG ADULTS IN EAST ASIA, IS AN EBV-ASSOCIATED T-/NK-CELL LYMPHOPROLIFERATIVE DISEASE. PATIENTS WITH CAEBV OFTEN PROGRESS TO OVERT LYMPHOMA OR LEUKEMIA OVER A LONG-TERM CLINICAL COURSE. EBV'S TRANSFORMING CAPACITY IN B CELLS IS WELL CHARACTERIZED, BUT THE MOLECULAR PATHOGENESIS OF CLONAL EXPANSION CAUSED BY EBV IN T/NK CELLS HAS NOT YET BEEN CLARIFIED. IN THE PRIMARY INFECTION, EBV INFECTS B CELLS AND EPITHELIAL CELLS AND MAY ALSO INFECT SOME T/NK CELLS. IN SOME INDIVIDUALS, BECAUSE OF POOR PRESENTATION BY SPECIFIC HUMAN LEUKOCYTE ANTIGENS OR THE GENETIC BACKGROUND, EBV-INFECTED T/NK CELLS EVADE HOST IMMUNITY AND SURVIVE. OCCASIONALLY, WITH THE HELP OF VIRAL ONCOGENES, EBV-ASSOCIATED T/NK LYMPHOPROLIFERATIVE DISEASES, SUCH AS CAEBV, MAY DEVELOP. THE SUBSEQUENT ACCUMULATION OF GENETIC MUTATIONS AND/OR EPIGENETIC MODIFICATIONS IN DRIVER GENES, SUCH AS DDX3X AND TP53, MAY LEAD TO OVERT LYMPHOMA AND LEUKEMIA. ACTIVATION-INDUCED CYTIDINE DEAMINASE AND THE APOBEC3 FAMILY, DRIVEN BY EBV INFECTION, MAY INDUCE CHROMOSOMAL RECOMBINATION AND SOMATIC MUTATIONS. 2018 5 3902 39 LEARNING FROM THE FAILURES OF DRUG DISCOVERY IN B-CELL NON-HODGKIN LYMPHOMAS AND PERSPECTIVES FOR THE FUTURE: CHRONIC LYMPHOCYTIC LEUKEMIA AND DIFFUSE LARGE B-CELL LYMPHOMA AS TWO ENDS OF A SPECTRUM IN DRUG DEVELOPMENT. DESPITE SUBSTANTIAL RECENT ADVANCES, THERE IS STILL AN UNMET NEED FOR BETTER THERAPIES IN B-CELL NON HODGKIN LYMPHOMAS (B-NHL), ESPECIALLY IN RELAPSED OR REFRACTORY DISEASE. MANY NOVEL TARGETED DRUGS HAVE BEEN DEVELOPED BASED ON A BETTER MOLECULAR UNDERSTANDING OF B-NHL. AREAS COVERED: THIS ARTICLE FOCUSES ON CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) AS A REPRESENTATIVE FOR INDOLENT LYMPHOMAS AND PARADIGMATIC FOR THE TREMENDOUS PROGRESS IN TREATING B-NHL ON THE ONE HAND AND DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) AS A REPRESENTATIVE FOR AGGRESSIVE LYMPHOMAS AND PARADIGMATIC FOR MANY UNSOLVED PROBLEMS IN LYMPHOMA TREATMENT OR THE OTHER HAND. WE HIGHLIGHT SALIENT POINTS IN CURRENT THERAPIES TARGETING GENETIC, EPIGENETIC, IMMUNOLOGICAL AND MICROENVIRONMENTAL ALTERATIONS. POSSIBLE REASONS FOR DRUG FAILURE IN CLINICAL TRIALS LIKE TUMOR HETEROGENEITY, CLONAL EVOLUTION AND DRUG RESISTANCE MECHANISMS ARE DISCUSSED. BASED THEREON, SOME PERSPECTIVES FOR FURTHER DRUG DISCOVERY ARE GIVEN. EXPERT OPINION: IN VIEW OF THE PATHOGENETIC COMPLEXITY OF LYMPHOMAS, THERAPIES TARGETING EXCLUSIVELY A SINGLE ALTERATION MAY FAIL BECAUSE RESISTANCE MECHANISMS ARE PRESENT EITHER INITIALLY OR EVOLVE DURING TREATMENT. THEREFORE, FUTURE THERAPIES IN B-NHL MAY HAVE TO TARGET THE GREATEST POSSIBLE NUMBER OF GENETIC, IMMUNOLOGICAL OR EPIGENETIC ALTERATIONS STILL ALLOWING TOLERABILITY AND TO MONITOR THESE ALTERATIONS DURING THERAPY. 2017 6 3305 26 HIGH-LEVEL EXPRESSION OF BCL3 DIFFERENTIATES T(2;5)(P23;Q35)-POSITIVE ANAPLASTIC LARGE CELL LYMPHOMA FROM HODGKIN DISEASE. ANAPLASTIC LARGE CELL LYMPHOMA (ALCL) WITH T(2;5)(P23;Q35) AND HODGKIN DISEASE (HD) SHARE MANY CELLULAR FEATURES, INCLUDING EXPRESSION OF CD30. WE COMPARED GENE EXPRESSION PROFILES OF 4 ALCL (KARPAS 299, SU-DHL-1, DEL, SR-786) AND 3 HD CELL LINES AND FOUND THAT BCL3, WHICH ENCODES A NUCLEAR PROTEIN BELONGING TO THE I KAPPA B FAMILY OF INHIBITORS OF NUCLEAR FACTOR-KAPPA B (NF-KAPPA B) TRANSCRIPTIONAL FACTORS, WAS EXPRESSED AT HIGHER LEVELS IN ALCL THAN HD. NORTHERN AND WESTERN BLOTTING ANALYSES CONFIRMED THE HIGH-LEVEL EXPRESSION OF BCL3 IN ALCL AT BOTH MRNA AND PROTEIN LEVELS. WE ESTABLISHED A REAL-TIME REVERSE TRANSCRIPTASE-MEDIATED POLYMERASE CHAIN REACTION ASSAY TO MEASURE THE BCL3 MRNA LEVEL AND FOUND A PREDOMINANT LEVEL OF BCL3 EXPRESSION IN T(2;5)(+) ALCL; THE LEVELS OF CELL LINES AND CLINICAL MATERIALS WERE COMPARABLE TO OR HIGHER THAN THAT OF A B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA CARRYING T(14;19)(Q32;Q13). SOUTHERN BLOTTING AND FLUORESCENCE IN SITU HYBRIDIZATION DISCLOSED THAT THE BCL3 GENE COPIES WERE AMPLIFIED IN SU-DHL-1, WHEREAS KARPAS 299 CARRIED 4 BCL3 GENE LOCI. THE BCL3 GENE CONTAINS 2 CYTOSINE-GUANINE DINUCLEOTIDE (CPG) ISLANDS, AND THE INTRAGENIC 3' CPG WAS ENTIRELY DEMETHYLATED IN SU-DHL-1 AND DEL. IN CONTRAST TO HD, IN WHICH NF-KAPPA B WAS CONSTITUTIVELY ACTIVATED, ALCL CELLS CONSISTENTLY SHOWED (P50)(2) HOMODIMER BINDING ACTIVITY ON ELECTROPHORETIC MOBILITY SHIFT ASSAY. IT IS SUGGESTED THAT THE HIGH-LEVEL NUCLEAR BCL-3 SEQUESTERS THE (P50)(2) HOMODIMER TO THE NUCLEUS, WHICH MAY ACCOUNT FOR THE CONTRADICTORY EFFECT OF CD30 STIMULATION ON ALCL AND HD. WE PROPOSE THAT BCL3 IS OVEREXPRESSED BY GENETIC AND EPIGENETIC MODIFICATIONS, POTENTIALLY CONTRIBUTING TO THE DEVELOPMENT OF T(2;5)(+) ALCL. 2003 7 5462 31 RESEARCH PROGRESS ON EPIGENETICS OF SMALL B-CELL LYMPHOMA. SMALL B-CELL LYMPHOMA IS THE CLASSIFICATION OF B-CELL CHRONIC LYMPHOPROLIFERATIVE DISORDERS THAT INCLUDE CHRONIC LYMPHOCYTIC LEUKAEMIA/SMALL LYMPHOCYTIC LYMPHOMA, FOLLICULAR LYMPHOMA, MANTLE CELL LYMPHOMA, MARGINAL ZONE LYMPHOMA, LYMPHOPLASMACYTIC LYMPHOMA/WALDENSTROM MACROGLOBULINEMIA. THE CLINICAL PRESENTATION IS SOMEWHAT HETEROGENEOUS, AND ITS OCCURRENCE AND DEVELOPMENT MECHANISMS ARE NOT YET PRECISE AND MAY INVOLVE EPIGENETIC CHANGES. EPIGENETIC ALTERATIONS MAINLY INCLUDE DNA METHYLATION, HISTONE MODIFICATION, AND NON-CODING RNA, WHICH ARE ESSENTIAL FOR GENETIC DETECTION, EARLY DIAGNOSIS, AND ASSESSMENT OF TREATMENT RESISTANCE IN SMALL B-CELL LYMPHOMA. AS CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA HAS ALREADY BEEN REPORTED IN THE LITERATURE, THIS ARTICLE FOCUSES ON SMALL B-CELL LYMPHOMAS SUCH AS FOLLICULAR LYMPHOMA, MANTLE CELL LYMPHOMA, MARGINAL ZONE LYMPHOMA, AND WALDENSTROM MACROGLOBULINEMIA. IT DISCUSSES RECENT DEVELOPMENTS IN EPIGENETIC RESEARCH TO DIAGNOSE AND TREAT THIS GROUP OF LYMPHOMAS. THIS REVIEW PROVIDES NEW IDEAS FOR THE TREATMENT AND PROGNOSIS ASSESSMENT OF SMALL B-CELL LYMPHOMA BY EXPLORING THE CONNECTION BETWEEN SMALL B-CELL LYMPHOMA AND EPIGENETICS. 2022 8 1040 29 CLINICAL AND GENETIC CHARACTERIZATION OF EPSTEIN-BARR VIRUS-ASSOCIATED T/NK-CELL LYMPHOPROLIFERATIVE DISEASES. BACKGROUND: EPSTEIN-BARR VIRUS (EBV)-ASSOCIATED T-/NATURAL KILLER (T/NK)-CELL LYMPHOPROLIFERATIVE DISEASES CLINICALLY TAKE ON VARIOUS FORMS, RANGING FROM AN INDOLENT COURSE TO AN AGGRESSIVE CONDITION. OBJECTIVE: CLINICALLY, FAILURE TO ESTABLISH PRECISE DIAGNOSIS AND PROVIDE PROPER TREATMENT MAKES IT DIFFICULT TO HELP PATIENTS. WE SOUGHT TO BETTER UNDERSTAND THE UNDERLYING PATHOGENESIS AND TO IDENTIFY GENETIC PROGNOSTIC FACTORS TO ACHIEVE BETTER TREATMENT EFFICACY. METHODS: IN THIS STUDY, 119 CASES OF EBV-ASSOCIATED LYMPHOPROLIFERATIVE DISEASES, INCLUDING EBV-ASSOCIATED HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (N = 46) AND CHRONIC ACTIVE EBV DISEASE OF T/NK CELL TYPE (N = 73), WERE RETROSPECTIVELY EXAMINED. RESULTS: ADULTS AGED >20 YEARS AT ONSET ACCOUNTED FOR 71.4% OF OUR COHORT. ABOUT 54.6% PATIENTS WITH UNFAVORABLE OVERALL SURVIVAL DEVELOPED HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS AND HAD HIGHER PLASMA EBV LOAD. ALLOGENIC HEMATOPOIETIC STEM-CELL TRANSPLANTATION WAS THE SOLE INDEPENDENT FAVORABLE FACTOR. WE SYSTEMATICALLY SCREENED GERMLINE AND SOMATIC ABERRATIONS BY WHOLE-EXOME AND TARGETED SEQUENCING. AMONG 372 ANTIVIRAL IMMUNITY GENES, GERMLINE VARIANTS OF 8 GENES WERE SIGNIFICANTLY ENRICHED. FROM A PANEL OF 24 DRIVER GENES, SOMATIC MUTATIONS WERE FREQUENTLY IDENTIFIED IN DOMINANT EBV-INFECTED T/NK CELLS. PATIENTS CARRYING ANY GERMLINE/SOMATIC ABERRATIONS IN EPIGENETIC MODIFIERS AND RIG-I-LIKE RECEPTOR (RLR) PATHWAY HAD WORSE OVERALL SURVIVAL THAN THOSE WITHOUT 2 TYPE ABERRATIONS. IMPORTANTLY, PATIENTS WITH IFIH1 AND/OR DDX3X ABERRATIONS IN THE RLR PATHWAY HAD HIGHER PLASMA AND NK-CELL EBV LOAD. KNOCKDOWN OF DDX3X IN NKYS CELLS DOWNREGULATED RLR SIGNALING ACTIVITIES AND ELEVATED THE EXPRESSION OF EBV-ENCODED ONCOGENES SUCH AS LMP1 AND EBNA1. CONCLUSION: GENETIC DEFECTS WERE PREVALENT IN ADULT EBV-ASSOCIATED HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS PATIENTS AND PATIENTS WITH CHRONIC ACTIVE EBV DISEASE OF T/NK CELL TYPE; THESE DEFECTS WERE ASSOCIATED WITH UNFAVORABLE PROGNOSIS. THESE FINDINGS CAN HELP CLINICIANS WORK OUT MORE PRECISE STAGING OF THE CONDITION AND PROVIDE NEW INSIGHTS INTO THESE EBV-ASSOCIATED DISEASES. 2023 9 5666 25 SF3B1-MUTATED CHRONIC LYMPHOCYTIC LEUKEMIA SHOWS EVIDENCE OF NOTCH1 PATHWAY ACTIVATION INCLUDING CD20 DOWNREGULATION. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS CHARACTERIZED BY A LOW CD20 EXPRESSION, IN PART EXPLAINED BY AN EPIGENETIC-DRIVEN DOWNREGULATION TRIGGERED BY MUTATIONS OF THE NOTCH1 GENE. IN THE PRESENT STUDY, BY TAKING ADVANTAGE OF A WIDE AND WELL-CHARACTERIZED CLL COHORT (N=537), WE DEMONSTRATE THAT CD20 EXPRESSION IS DOWNREGULATED IN SF3B1-MUTATED CLL IN AN EXTENT SIMILAR TO NOTCH1-MUTATED CLL. IN FACT, SF3B1-MUTATED CLL CELLS SHOW COMMON FEATURES WITH NOTCH1-MUTATED CLL CELLS, INCLUDING A GENE EXPRESSION PROFILE ENRICHED OF NOTCH1-RELATED GENE SETS AND ELEVATED EXPRESSION OF THE ACTIVE INTRACYTOPLASMIC NOTCH1. ACTIVATION OF THE NOTCH1 SIGNALING AND DOWN-REGULATION OF SURFACE CD20 IN SF3B1-MUTATED CLL CELLS CORRELATE WITH OVER-EXPRESSION OF AN ALTERNATIVELY SPLICED FORM OF DVL2, A COMPONENT OF THE WNT PATHWAY AND NEGATIVE REGULATOR OF THE NOTCH1 PATHWAY. THESE FINDINGS ARE CONFIRMED BY SEPARATELY ANALYZING THE CD20-DIM AND CD20-BRIGHT CELL FRACTIONS FROM SF3B1-MUTATED CASES AS WELL AS BY DVL2 KNOCK-OUT EXPERIMENTS IN CLL-LIKE CELL MODELS. ALTOGETHER, THE CLINICAL AND BIOLOGICAL FEATURES THAT CHARACTERIZE NOTCH1-MUTATED CLL MAY ALSO BE RECAPITULATED IN SF3B1-MUTATED CLL, CONTRIBUTING TO EXPLAIN THE POOR PROGNOSIS OF THIS CLL SUBSET AND PROVIDING THE RATIONALE FOR EXPANDING NOVEL AGENTS-BASED THERAPIES TO SF3B1-MUTATED CLL. 2021 10 6171 24 THE HDAC INHIBITOR VALPROATE INDUCES A BIVALENT STATUS OF THE CD20 PROMOTER IN CLL PATIENTS SUGGESTING DISTINCT EPIGENETIC REGULATION OF CD20 EXPRESSION IN CLL IN VIVO. TREATMENT WITH ANTI-CD20 ANTIBODIES IS ONLY MODERATELY EFFICIENT IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), A FEATURE WHICH HAS BEEN EXPLAINED BY THE INHERENTLY LOW CD20 EXPRESSION IN CLL. IT HAS BEEN SHOWN THAT CD20 IS EPIGENETICALLY REGULATED AND THAT HISTONE DEACETYLASE INHIBITORS (HDACIS) CAN INCREASE CD20 EXPRESSION IN VITRO IN CLL. TO ASSESS WHETHER HDACIS CAN UPREGULATE CD20 ALSO IN VIVO IN CLL, THE HDACI VALPROATE WAS GIVEN TO THREE DEL13Q/NOTCH1WT CLL PATIENTS AND CD20 LEVELS WERE ANALYSED (THE PREVAIL STUDY). VALPROATE TREATMENT RESULTED IN EXPECTED GLOBAL ACTIVATING HISTONE MODIFICATIONS SUGGESTING HDAC INHIBITORY EFFECTS. HOWEVER, ALTHOUGH VALPROATE INDUCED EXPRESSION OF CD20 MRNA AND PROTEIN IN THE DEL13Q/NOTCH1WT I83-E95 CLL CELL LINE, NO SUCH EFFECTS WERE OBSERVED IN THE PATIENTS STUDIED. IN CONTRAST TO THE CELL LINE, IN PATIENTS VALPROATE TREATMENT RESULTED IN TRANSIENT RECRUITMENT OF THE TRANSCRIPTIONAL REPRESSOR EZH2 TO THE CD20 PROMOTER, CORRELATING TO AN INCREASE OF THE REPRESSIVE HISTONE MARK H3K27ME3. THIS SUGGESTS THAT VALPROATE-MEDIATED INDUCTION OF CD20 MAY BE HAMPERED BY EZH2 MEDIATED H3K27ME3 IN VIVO IN CLL. MOREOVER, VALPROATE TREATMENT RESULTED IN INDUCTION OF EZH2 AND GLOBAL H3K27ME3 IN PATIENT CELLS, SUGGESTING TRANSCRIPTIONALLY REPRESSIVE EFFECTS OF VALPROATE IN CLL. OUR RESULTS SUGGEST NEW IN VIVO MECHANISMS OF HDACIS WHICH MAY HAVE IMPLICATIONS ON THE DESIGN OF FUTURE CLINICAL TRIALS IN B-CELL MALIGNANCIES. 2017 11 1044 31 CLINICAL CHARACTERISTICS OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS ASSOCIATED WITH NON-HODGKIN B-CELL LYMPHOMA: A MULTICENTER RETROSPECTIVE STUDY. BACKGROUND: HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH) ASSOCIATED WITH B-CELL LYMPHOMA IS A HIGHLY AGGRESSIVE DISEASE WITH UNCLEAR CLINICAL FEATURES AND HAS NO STANDARD TREATMENT. PATIENTS AND METHODS: WE ANALYZED THE CLINICAL CHARACTERISTICS OF 31 PATIENTS FROM TWO INDIVIDUAL CENTERS. RESULTS: THE MEDIAN OVERALL SURVIVAL WAS ONLY 1.5 MONTHS. BOTH UNIVARIATE AND MULTIVARIATE ANALYSES, BASED ON LYMPHOMA OR HLH-RELATED CHARACTERISTICS, REVEALED THAT PATIENTS WITH HIGH EPSTEIN-BARR VIRUS (EBV) DNA LOAD AND >/= 2 EXTRANODAL LESIONS, OR HYPOFIBRINOGENEMIA, RESPECTIVELY, SHOWED SIGNIFICANTLY POORER OVERALL SURVIVAL. INTERESTINGLY, SOME PATIENTS WITH HIGH EBV DNA LOAD HAD EBV-POSITIVE NATURAL KILLER (NK) AND/OR T CELLS, WHICH MAY BE RELATED TO THE COEXISTENCE OF IMMUNODEFICIENCY AND/OR CHRONIC ACTIVE EBV INFECTION. MOLECULAR GENETICS EXAMINATION CONFIRMED THAT 47.4% (9/19) OF PATIENTS HAD COMPLEX KARYOTYPES, 37.5% (3/8) OF PATIENTS HAD TP53 DELETIONS, AND 21.34% (3/14) OF PATIENTS HAD TP53 MUTATION OR ALTERATION OF MALIGNANCY-RELATED PATHWAYS, INCLUDING BCR/NF-KAPPAB, JAK-STAT, AND EPIGENETIC REGULATORY PATHWAYS, WHICH MAY PROVIDE CLUES TO CHOOSE TARGETS FOR THERAPY. TREATMENT REGIMENS CONTAINING ETOPOSIDE, ANTI-CD20 MONOCLONAL ANTIBODIES, OR ANTHRACYCLINES IMPROVED PATIENT PROGNOSIS (P = .0183, .025, AND .0436, RESPECTIVELY). PATIENTS WITH INFECTIONS HAD SIGNIFICANTLY SHORTER SURVIVAL THAN THOSE WITHOUT INFECTIONS (P = .00019). CONCLUSION: THE PATIENTS' PERFORMANCE STATUS, NUMBER OF EXTRANODAL LESIONS, HIGH EBV DNA LOAD, AND HYPOFIBRINOGENEMIA ARE POOR PROGNOSTIC FACTORS FOR HLH ASSOCIATED WITH B-CELL LYMPHOMA. MOLECULAR GENETIC HIGH-RISK FACTORS ARE OF PARTICULAR IMPORTANCE BECAUSE THESE FACTORS CAN PROVIDE INFORMATION FOR PROGNOSIS PREDICTION, TREATMENT DECISIONS, AND DISEASE SURVEILLANCE. 2021 12 1693 27 DUSP4 DEFICIENCY CAUSED BY PROMOTER HYPERMETHYLATION DRIVES JNK SIGNALING AND TUMOR CELL SURVIVAL IN DIFFUSE LARGE B CELL LYMPHOMA. THE EPIGENETIC DYSREGULATION OF TUMOR SUPPRESSOR GENES IS AN IMPORTANT DRIVER OF HUMAN CARCINOGENESIS. WE HAVE COMBINED GENOME-WIDE DNA METHYLATION ANALYSES AND GENE EXPRESSION PROFILING AFTER PHARMACOLOGICAL DNA DEMETHYLATION WITH FUNCTIONAL SCREENING TO IDENTIFY NOVEL TUMOR SUPPRESSORS IN DIFFUSE LARGE B CELL LYMPHOMA (DLBCL). WE FIND THAT A CPG ISLAND IN THE PROMOTER OF THE DUAL-SPECIFICITY PHOSPHATASE DUSP4 IS ABERRANTLY METHYLATED IN NODAL AND EXTRANODAL DLBCL, IRRESPECTIVE OF ABC OR GCB SUBTYPE, RESULTING IN LOSS OF DUSP4 EXPRESSION IN 75% OF >200 EXAMINED CASES. THE DUSP4 GENOMIC LOCUS IS FURTHER DELETED IN UP TO 13% OF AGGRESSIVE B CELL LYMPHOMAS, AND THE LACK OF DUSP4 IS A NEGATIVE PROGNOSTIC FACTOR IN THREE INDEPENDENT COHORTS OF DLBCL PATIENTS. ECTOPIC EXPRESSION OF WILD-TYPE DUSP4, BUT NOT OF A PHOSPHATASE-DEFICIENT MUTANT, DEPHOSPHORYLATES C-JUN N-TERMINAL KINASE (JNK) AND INDUCES APOPTOSIS IN DLBCL CELLS. PHARMACOLOGICAL OR DOMINANT-NEGATIVE JNK INHIBITION RESTRICTS DLBCL SURVIVAL IN VITRO AND IN VIVO AND SYNERGIZES STRONGLY WITH THE BRUTON'S TYROSINE KINASE INHIBITOR IBRUTINIB. OUR RESULTS INDICATE THAT DLBCL CELLS DEPEND ON JNK SIGNALING FOR SURVIVAL. THIS FINDING PROVIDES A MECHANISTIC BASIS FOR THE CLINICAL DEVELOPMENT OF JNK INHIBITORS IN DLBCL, IDEALLY IN SYNTHETIC LETHAL COMBINATIONS WITH INHIBITORS OF CHRONIC ACTIVE B CELL RECEPTOR SIGNALING. 2015 13 5663 26 SEZARY SYNDROME COEXISTING WITH B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA: CASE REPORT AND REVIEW OF THE LITERATURE. INTRODUCTION: THE SIMULTANEOUS PRESENTATION OF CHRONIC B-CELL LYMPHOCYTIC LEUKEMIA (B-CLL) AND CUTANEOUS T-CELL LYMPHOMA (CTCL) IS EXTREMELY RARE. CASE REPORT: WE DESCRIBE A PATIENT WITH B-CLL AND SEZARY SYNDROME (SS), AN ERYTHRODERMIC AND LEUKEMIC VARIANT OF CTCL. DESPITE TREATMENT, THE SS PROGRESSED TO INVOLVE INTERNAL ORGANS AND EVENTUAL DEATH OF THE PATIENT FROM SEPSIS. THIS IS THE FIRST REPORTED CASE OF SS COEXISTING WITH CHRONIC LYMPHOCYTIC LEUKEMIA IN WHICH AN ANTI-V BETA 13.6 ANTIBODY WAS USED TO SERIALLY TRACK CHANGES IN CIRCULATING NEOPLASTIC T CELLS VIS-A-VIS NEOPLASTIC B CELLS AND TO DETECT NEOPLASTIC T CELLS IN ASCITIC FLUID NEAR THE END OF THE PATIENT'S LIFE. DISCUSSION: WE SPECULATE THAT THE COEXISTENCE OF B-CLL AND CTCL IS THE RESULT OF AN INITIATING GENETIC OR EPIGENETIC DEFECT AT THE LEVEL OF THE COMMON LYMPHOID STEM CELL THAT PREDISPOSES BOTH B-CELL AND T-CELL LINEAGES TO ADDITIONAL ONCOGENIC CHANGES AT A MORE ADVANCED STAGE OF DIFFERENTIATION. 2008 14 941 38 CHRONIC LYMPHOCYTIC LEUKEMIA B-CELL NORMAL CELLULAR COUNTERPART: CLUES FROM A FUNCTIONAL PERSPECTIVE. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS CHARACTERIZED BY THE CLONAL EXPANSION OF SMALL MATURE-LOOKING CD19+ CD23+ CD5+ B-CELLS THAT ACCUMULATE IN THE BLOOD, BONE MARROW, AND LYMPHOID ORGANS. TO DATE, NO CONSENSUS HAS BEEN REACHED CONCERNING THE NORMAL CELLULAR COUNTERPART OF CLL B-CELLS AND SEVERAL B-CELL TYPES HAVE BEEN PROPOSED. CLL B-CELLS HAVE REMARKABLE PHENOTYPIC AND GENE EXPRESSION PROFILE HOMOGENEITY. IN RECENT YEARS, THE MOLECULAR AND CELLULAR BIOLOGY OF CLL HAS BEEN ENRICHED BY SEMINAL INSIGHTS THAT ARE LEADING TO A BETTER UNDERSTANDING OF THE NATURAL HISTORY OF THE DISEASE. IMMUNOPHENOTYPIC AND MOLECULAR APPROACHES (INCLUDING IMMUNOGLOBULIN HEAVY-CHAIN VARIABLE GENE MUTATIONAL STATUS, TRANSCRIPTIONAL AND EPIGENETIC PROFILING) COMPARING THE NORMAL B-CELL SUBSET AND CLL B-CELLS PROVIDE SOME NEW INSIGHTS INTO THE NORMAL CELLULAR COUNTERPART. FUNCTIONAL CHARACTERISTICS (INCLUDING ACTIVATION REQUIREMENTS AND PROPENSITY FOR PLASMA CELL DIFFERENTIATION) OF CLL B-CELLS HAVE NOW BEEN INVESTIGATED FOR 50 YEARS. B-CELL SUBSETS DIFFER SUBSTANTIALLY IN TERMS OF THEIR FUNCTIONAL FEATURES. ANALYSIS OF SHARED FUNCTIONAL CHARACTERISTICS MAY REVEAL SIMILARITIES BETWEEN NORMAL B-CELL SUBSETS AND CLL B-CELLS, ALLOWING SPECULATIVE ASSIGNMENT OF A NORMAL CELLULAR COUNTERPART FOR CLL B-CELLS. IN THIS REVIEW, WE SUMMARIZE CURRENT DATA REGARDING PERIPHERAL B-CELL DIFFERENTIATION AND HUMAN B-CELL SUBSETS AND SUGGEST POSSIBILITIES FOR A NORMAL CELLULAR COUNTERPART BASED ON THE FUNCTIONAL CHARACTERISTICS OF CLL B-CELLS. HOWEVER, A DEFINITIVE NORMAL CELLULAR COUNTERPART CANNOT BE ATTRIBUTED ON THE BASIS OF THE AVAILABLE DATA. WE DISCUSS THE FUNCTIONAL CHARACTERISTICS REQUIRED FOR A CELL TO BE LOGICALLY CONSIDERED TO BE THE NORMAL COUNTERPART OF CLL B-CELLS. 2018 15 4729 25 NOTCH1 MUTATIONS ASSOCIATE WITH LOW CD20 LEVEL IN CHRONIC LYMPHOCYTIC LEUKEMIA: EVIDENCE FOR A NOTCH1 MUTATION-DRIVEN EPIGENETIC DYSREGULATION. IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), NOTCH1 MUTATIONS HAVE BEEN ASSOCIATED WITH CLINICAL RESISTANCE TO THE ANTI-CD20 RITUXIMAB, ALTHOUGH THE MECHANISMS BEHIND THIS PECULIAR BEHAVIOR REMAIN TO BE CLARIFIED. IN A WIDE CLL SERIES (N=692), WE DEMONSTRATED THAT CLL CELLS FROM NOTCH1-MUTATED CASES (87/692) WERE CHARACTERIZED BY LOWER CD20 EXPRESSION AND LOWER RELATIVE LYSIS INDUCED BY ANTI-CD20 EXPOSURE IN VITRO. CONSISTENTLY, CD20 EXPRESSION BY CLL CELLS WAS UPREGULATED IN VITRO BY GAMMA-SECRETASE INHIBITORS OR NOTCH1-SPECIFIC SMALL INTERFERING RNA AND THE STABLE TRANSFECTION OF A MUTATED (C.7541-7542DELCT) NOTCH1 INTRACELLULAR DOMAIN (NICD-MUT) INTO CLL-LIKE CELLS RESULTED IN A STRONG DOWNREGULATION OF BOTH CD20 PROTEIN AND TRANSCRIPT. BY USING THESE NICD-MUT TRANSFECTANTS, WE INVESTIGATED PROTEIN INTERACTIONS OF RBPJ, A TRANSCRIPTION FACTOR ACTING EITHER AS ACTIVATOR OR REPRESSOR OF NOTCH1 PATHWAY WHEN RESPECTIVELY BOUND TO NICD OR HISTONE DEACETYLASES (HDACS). COMPARED WITH CONTROLS, NICD-MUT TRANSFECTANTS HAD RBPJ PREFERENTIALLY COMPLEXED TO NICD AND SHOWED HIGHER LEVELS OF HDACS INTERACTING WITH THE PROMOTER OF THE CD20 GENE. FINALLY, TREATMENT WITH THE HDAC INHIBITOR VALPROIC ACID UPREGULATED CD20 IN BOTH NICD-MUT TRANSFECTANTS AND PRIMARY CLL CELLS. IN CONCLUSION, NOTCH1 MUTATIONS ARE ASSOCIATED WITH LOW CD20 LEVELS IN CLL AND ARE RESPONSIBLE FOR A DYSREGULATION OF HDAC-MEDIATED EPIGENETIC REPRESSION OF CD20 EXPRESSION. 2016 16 1273 29 CYTOTOXIC PERIPHERAL T-CELL LYMPHOMAS AND EBV-POSITIVE T/NK-CELL LYMPHOPROLIFERATIVE DISEASES: EMERGING CONCEPTS, RECENT ADVANCES, AND THE PUTATIVE ROLE OF CLONAL HEMATOPOIESIS. A REPORT OF THE 2022 EA4HP/SH LYMPHOMA WORKSHOP. CYTOTOXIC PERIPHERAL T-CELL LYMPHOMAS AND EBV-POSITIVE T/NK-CELL LYMPHOPROLIFERATIVE DISEASES WERE DISCUSSED AT THE 2022 EUROPEAN ASSOCIATION FOR HAEMATOPATHOLOGY/SOCIETY FOR HEMATOPATHOLOGY LYMPHOMA WORKSHOP HELD IN FLORENCE, ITALY. THIS SESSION FOCUSED ON (I) PRIMARY NODAL EBV-POSITIVE T AND NK-CELL LYMPHOMAS (PRIMARY NODAL-EBV-TNKL), (II) EXTRANODAL EBV-POSITIVE T/NK LYMPHOPROLIFERATIVE DISEASES (LPD) IN CHILDREN AND ADULTS, (III) CYTOTOXIC PERIPHERAL T-CELL LYMPHOMAS, NOS (CPTCL-NOS), EBV-NEGATIVE, AND (IV) MISCELLANEOUS CASES. PRIMARY NODAL-EBV-TNKL IS A NEWLY RECOGNIZED ENTITY WHICH IS RARE, AGGRESSIVE, AND ASSOCIATED WITH UNDERLYING IMMUNE DEFICIENCY/IMMUNE DYSREGULATION. ALL CASES PRESENTED WITH LYMPHADENOPATHY BUT SOME DEMONSTRATED INVOLVEMENT OF TONSIL/WALDEYER'S RING AND EXTRANODAL SITES. THE MAJORITY OF TUMORS ARE OF T-CELL LINEAGE, AND THE MOST FREQUENT MUTATIONS INVOLVE THE EPIGENETIC MODIFIER GENES, SUCH AS TET2 AND DNMT3A, AND JAK-STAT GENES. A SPECTRUM OF EBV-POSITIVE T/NK LPD INVOLVING EXTRANODAL SITES WERE DISCUSSED AND HIGHLIGHT THE DIAGNOSTIC CHALLENGE WITH PRIMARY NODAL-EBV-TNKL WHEN THESE EXTRANODAL EBV-POSITIVE T/NK LPD CASES DEMONSTRATE PREDOMINANT NODAL DISEASE EITHER AT PRESENTATION OR DURING DISEASE PROGRESSION FROM CHRONIC ACTIVE EBV DISEASE. THE MAJORITY OF CPTCL-NOS DEMONSTRATED THE TBX21 PHENOTYPE. SOME CASES HAD A BACKGROUND OF IMMUNOSUPPRESSION OR IMMUNE DYSREGULATION. INTERESTINGLY, AN UNEXPECTED ASSOCIATION OF CPTCL-NOS, EBV-POSITIVE AND NEGATIVE, WITH TFH LYMPHOMAS/LPDS WAS OBSERVED IN THE WORKSHOP CASES. SIMILAR TO A PUBLISHED LITERATURE, THE GENETIC LANDSCAPE OF CPTCL-NOS FROM THE WORKSHOP SHOWED FREQUENT MUTATIONS IN EPIGENETIC MODIFIERS, INCLUDING TET2 AND DNMT3A, SUGGESTING A ROLE OF CLONAL HEMATOPOIESIS IN THE DISEASE PATHOGENESIS. 2023 17 3024 29 GENETICS AND PATHOGENESIS OF DIFFUSE LARGE B-CELL LYMPHOMA. BACKGROUND: DIFFUSE LARGE B-CELL LYMPHOMAS (DLBCLS) ARE PHENOTYPICALLY AND GENETICALLY HETEROGENEOUS. GENE-EXPRESSION PROFILING HAS IDENTIFIED SUBGROUPS OF DLBCL (ACTIVATED B-CELL-LIKE [ABC], GERMINAL-CENTER B-CELL-LIKE [GCB], AND UNCLASSIFIED) ACCORDING TO CELL OF ORIGIN THAT ARE ASSOCIATED WITH A DIFFERENTIAL RESPONSE TO CHEMOTHERAPY AND TARGETED AGENTS. WE SOUGHT TO EXTEND THESE FINDINGS BY IDENTIFYING GENETIC SUBTYPES OF DLBCL BASED ON SHARED GENOMIC ABNORMALITIES AND TO UNCOVER THERAPEUTIC VULNERABILITIES BASED ON TUMOR GENETICS. METHODS: WE STUDIED 574 DLBCL BIOPSY SAMPLES USING EXOME AND TRANSCRIPTOME SEQUENCING, ARRAY-BASED DNA COPY-NUMBER ANALYSIS, AND TARGETED AMPLICON RESEQUENCING OF 372 GENES TO IDENTIFY GENES WITH RECURRENT ABERRATIONS. WE DEVELOPED AND IMPLEMENTED AN ALGORITHM TO DISCOVER GENETIC SUBTYPES BASED ON THE CO-OCCURRENCE OF GENETIC ALTERATIONS. RESULTS: WE IDENTIFIED FOUR PROMINENT GENETIC SUBTYPES IN DLBCL, TERMED MCD (BASED ON THE CO-OCCURRENCE OF MYD88(L265P) AND CD79B MUTATIONS), BN2 (BASED ON BCL6 FUSIONS AND NOTCH2 MUTATIONS), N1 (BASED ON NOTCH1 MUTATIONS), AND EZB (BASED ON EZH2 MUTATIONS AND BCL2 TRANSLOCATIONS). GENETIC ABERRATIONS IN MULTIPLE GENES DISTINGUISHED EACH GENETIC SUBTYPE FROM OTHER DLBCLS. THESE SUBTYPES DIFFERED PHENOTYPICALLY, AS JUDGED BY DIFFERENCES IN GENE-EXPRESSION SIGNATURES AND RESPONSES TO IMMUNOCHEMOTHERAPY, WITH FAVORABLE SURVIVAL IN THE BN2 AND EZB SUBTYPES AND INFERIOR OUTCOMES IN THE MCD AND N1 SUBTYPES. ANALYSIS OF GENETIC PATHWAYS SUGGESTED THAT MCD AND BN2 DLBCLS RELY ON "CHRONIC ACTIVE" B-CELL RECEPTOR SIGNALING THAT IS AMENABLE TO THERAPEUTIC INHIBITION. CONCLUSIONS: WE UNCOVERED GENETIC SUBTYPES OF DLBCL WITH DISTINCT GENOTYPIC, EPIGENETIC, AND CLINICAL CHARACTERISTICS, PROVIDING A POTENTIAL NOSOLOGY FOR PRECISION-MEDICINE STRATEGIES IN DLBCL. (FUNDED BY THE INTRAMURAL RESEARCH PROGRAM OF THE NATIONAL INSTITUTES OF HEALTH AND OTHERS.). 2018 18 1467 32 DISTINCT CLINICAL AND GENETIC FEATURES OF HEPATITIS B VIRUS-ASSOCIATED FOLLICULAR LYMPHOMA IN CHINESE PATIENTS. HEPATITIS B VIRUS (HBV) INFECTION HAS BEEN ASSOCIATED WITH AN INCREASED RISK FOR B-CELL LYMPHOMAS. WE PREVIOUSLY SHOWED THAT 20% OF DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) PATIENTS FROM CHINA, AN ENDEMIC AREA OF HBV INFECTION, HAVE CHRONIC HBV INFECTION (SURFACE ANTIGEN-POSITIVE, HBSAG+) AND ARE CHARACTERIZED BY DISTINCT CLINICAL AND GENETIC FEATURES. HERE, WE SHOWED THAT 24% OF FOLLICULAR LYMPHOMA (FL) CHINESE PATIENTS ARE HBSAG+. COMPARED WITH THE HBSAG- FL PATIENTS, HBSAG+ PATIENTS ARE YOUNGER, HAVE A HIGHER HISTOLOGICAL GRADE AT DIAGNOSIS, AND HAVE A HIGHER INCIDENCE OF DISEASE PROGRESSION WITHIN 24 MONTHS. MOREOVER, BY SEQUENCING THE GENOMES OF 109 FL TUMORS, WE OBSERVED ENHANCED MUTAGENESIS AND DISTINCT GENETIC PROFILE IN HBSAG+ FLS, WITH A UNIQUE SET OF PREFERENTIALLY MUTATED GENES (TNFAIP3, FAS, HIST1H1C, KLF2, TP53, PIM1, TMSB4X, DUSP2, TAGAP, LYN, AND SETD2) BUT LACK OF THE HALLMARK OF HBSAG- FLS (IE, IGH/BCL2 TRANSLOCATIONS AND CREBBP MUTATIONS). TRANSCRIPTOMIC ANALYSES FURTHER SHOWED THAT HBSAG+ FLS DISPLAYED GENE-EXPRESSION SIGNATURES RESEMBLING THE ACTIVATED B-CELL-LIKE SUBTYPE OF DIFFUSE LARGE B-CELL LYMPHOMA, INVOLVING IRF4-TARGETED GENES AND NF-KAPPAB/MYD88 SIGNALING PATHWAYS. FINALLY, WE IDENTIFIED AN INCREASED INFILTRATION OF CD8+ MEMORY T CELLS, CD4+ TH1 CELLS, AND M1 MACROPHAGES AND HIGHER T-CELL EXHAUSTION GENE SIGNATURE IN HBSAG+ FL SAMPLES. TAKEN TOGETHER, WE PRESENT NEW GENETIC/EPIGENETIC EVIDENCE THAT LINKS CHRONIC HBV INFECTION TO B-CELL LYMPHOMAGENESIS, AND HBV-ASSOCIATED FL IS LIKELY TO HAVE A DISTINCT CELL-OF-ORIGIN AND REPRESENT AS A SEPARATE SUBTYPE OF FL. TARGETABLE GENETIC/EPIGENETIC ALTERATIONS IDENTIFIED IN TUMORS AND THEIR ASSOCIATED TUMOR MICROENVIRONMENT MAY PROVIDE POTENTIAL NOVEL THERAPEUTIC APPROACHES FOR THIS SUBGROUP OF PATIENTS. 2022 19 557 31 B-CELL ANTIGEN RECEPTOR SIGNALING IN CHRONIC LYMPHOCYTIC LEUKEMIA: THERAPEUTIC TARGETS AND TRANSLATIONAL OPPORTUNITIES. B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS CHARACTERIZED BY CLONALLY EXPANDED AND MOLECULARLY HETEROGENEOUS POPULATIONS OF B LYMPHOCYTES WITH IMPAIRED APOPTOTIC MECHANISMS. THIS OCCURS AS A RESULT OF MULTIPLE GENETIC AND EPIGENETIC ABNORMALITIES, INCLUDING CHROMOSOMAL ABERRATIONS AND ENHANCER REGION HYPOMETHYLATION, OFTEN IMPINGING ON INTRACELLULAR SIGNALING PATHWAYS THAT ARE ESSENTIAL TO NORMAL B-CELL ACTIVATION, PROLIFERATION, AND SURVIVAL. THE B-CELL ANTIGEN RECEPTOR (BCR) SIGNALING IS ONE SUCH PATHWAY USURPED BY MALIGNANT B CELLS, AS EXEMPLIFIED BY THE EARLY PHASE CLINICAL SUCCESS ACHIEVED BY SMALL-MOLECULE AGENTS TARGETING KEY PLAYERS INVOLVED IN THE PATHWAY. SUCH NEW TARGETED AGENTS, INCLUDING THOSE THAT INHIBIT THE FUNCTION OF SPLEEN TYROSINE KINASE (SYK), BRUTON'S TYROSINE KINASE (BTK), PHOSPHATIDYLINOSITOL 3-KINASES (PI3K), AND B-CELL LYMPHOMA 2 (BCL-2), ALONG WITH THE CURRENT STANDARD THERAPY COMPRISING CHEMO-IMMUNOTHERAPIES WITH OR WITHOUT B-CELL DEPLETING BIOLOGIC AGENT RITUXIMAB (ANTI-CD20 MONOCLONAL ANTIBODY), SHOULD EXPAND THE ARMAMENTARIUM FOR CLL THERAPY. WE REVIEW THE THERAPEUTIC AGENTS CURRENTLY IN CLINICAL DEVELOPMENT WHICH TARGET DIFFERENT EFFECTORS OF THE MALIGNANT BCR SIGNALING, AND DISCUSS THEIR OVERLAPPING AND DISCRIMINATING TRANSLATIONAL OPPORTUNITIES IN THE CONTEXT OF CLL TREATMENT. 2013 20 940 34 CHRONIC LYMPHOCYTIC LEUKEMIA AND MANTLE CELL LYMPHOMA: CROSSROADS OF GENETIC AND MICROENVIRONMENT INTERACTIONS. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) AND MANTLE CELL LYMPHOMA (MCL) ARE 2 WELL-DEFINED ENTITIES THAT DIVERGE IN THEIR BASIC PATHOGENIC MECHANISMS AND CLINICAL EVOLUTION BUT THEY SHARE EPIDEMIOLOGICAL CHARACTERISTICS, CELLS OF ORIGIN, MOLECULAR ALTERATIONS, AND CLINICAL FEATURES THAT DIFFER FROM OTHER LYMPHOID NEOPLASMS. CLL AND MCL ARE CLASSICALLY CONSIDERED INDOLENT AND AGGRESSIVE NEOPLASMS, RESPECTIVELY. HOWEVER, THE CLINICAL EVOLUTION OF BOTH TUMORS IS VERY HETEROGENEOUS, WITH SUBSETS OF PATIENTS HAVING STABLE DISEASE FOR A LONG TIME WHEREAS OTHERS REQUIRE IMMEDIATE INTERVENTION. BOTH CLL AND MCL INCLUDE 2 MAJOR MOLECULAR SUBTYPES THAT SEEM TO DERIVE FROM ANTIGEN-EXPERIENCED CD5(+) B CELLS THAT RETAIN A NAIVE OR MEMORY-LIKE EPIGENETIC SIGNATURE AND CARRY A VARIABLE LOAD OF IMMUNOGLOBULIN HEAVY-CHAIN VARIABLE REGION SOMATIC MUTATIONS FROM TRULY UNMUTATED TO HIGHLY MUTATED, RESPECTIVELY. THESE 2 SUBTYPES OF TUMORS DIFFER IN THEIR MOLECULAR PATHWAYS, GENOMIC ALTERATIONS, AND CLINICAL BEHAVIOR, BEING MORE AGGRESSIVE IN NAIVE-LIKE THAN MEMORY-LIKE-DERIVED TUMORS IN BOTH CLL AND MCL. THE PATHOGENESIS OF THE 2 ENTITIES INTEGRATES THE RELEVANT INFLUENCE OF B-CELL RECEPTOR SIGNALING, TUMOR CELL MICROENVIRONMENT INTERACTIONS, GENOMIC ALTERATIONS, AND EPIGENOME MODIFICATIONS THAT CONFIGURE THE EVOLUTION OF THE TUMORS AND OFFER NEW POSSIBILITIES FOR THERAPEUTIC INTERVENTION. THIS REVIEW WILL FOCUS ON THE SIMILARITIES AND DIFFERENCES OF THESE 2 TUMORS BASED ON RECENT STUDIES THAT ARE ENHANCING THE UNDERSTANDING OF THEIR PATHOGENESIS AND CREATING SOLID BASES FOR NEW MANAGEMENT STRATEGIES. 2018