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Genetics of follicular lymphoma transformation

Pasqualucci, Laura; Khiabanian, Hossein; Fangazio, Marco; Vasishtha, Mansi; Messina, Monica; Holmes, Antony B.; Ouillette, Peter; Trifonov, Vladimir; Rossi, Davide; Tabbò, Fabrizio; Ponzoni, Maurilio; Chadburn, Amy; Vundavalli, Murty V.; Bhagat, Govind; Gaidano, Gianluca; Inghirami, Giorgio; Malek, Sami N.; Rabadan, Raul; Dalla-Favera, Riccardo

Follicular lymphoma (FL) is an indolent disease, but 30-40% of cases undergo histologic transformation to an aggressive malignancy, typically represented by diffuse large B cell lymphoma (DLBCL). The pathogenesis of this process remains largely unknown. Using whole- exome sequencing and copy-number analysis, here we show that the dominant clone of FL and transformed FL (tFL) arise by divergent evolution from a common mutated precursor through the acquisition of distinct genetic events. Mutations in epigenetic modifiers and anti-apoptotic genes are introduced early in the common precursor, while tFL is specifically associated with alterations deregulating cell-cycle progression and DNA-damage responses (CDKN2A/B, MYC, TP53), as well as with aberrant somatic hypermutation. The genomic profile of tFL shares similarities with that of germinal center B-cell-type de novo DLBCL, but also displays unique combinations of altered genes, with diagnostic and therapeutic implications.

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