3 Abstract The doctor thesis is composed of two major studies, both of them focused on the mantle cell lymphoma (MCL). The first part deals with the verification of the prognostic influence of Mantle Cell Lymphoma International Prognostic Index (MIPI) and of the proliferative activity in 235 patients with MCL diagnosed in 1996-2008 in the Czech Republic. This population study was performed in the collaboration with the Czech Lymphoma Study Group. The clinical data of patients were completed in April 2012. The diagnosis of MCL was confirmed by our central histopathologic examination of pretherapeutic histological samples. The median overall survival (OS) was 47 months, median progression free survival (PFS) was 22 months. We demonstrated the influence of proliferative activity, MIPI and of the therapy type (intensive/non-intensive) on OS and PFS in univariate and multivariate analysis. Using univariate analysis we showed the prognostic influence of aggressive/other cytomorphological variants of MCL, nodal/extranodal localization of primary sample and also of the variants of MIPI - s-MIPI, MIPIb and a completely new variant of MIPI - combined MIPI. The prognostic influence of growth pattern and of the results of immunohistochemical reaction with CD23, CD5 and cyclin D1 antibodies were not confirmed. The other...

3 Abstract The doctor thesis is composed of two major studies, both of them focused on the mantle cell lymphoma (MCL). The first part deals with the verification of the prognostic influence of Mantle Cell Lymphoma International Prognostic Index (MIPI) and of the proliferative activity in 235 patients with MCL diagnosed in 1996-2008 in the Czech Republic. This population study was performed in the collaboration with the Czech Lymphoma Study Group. The clinical data of patients were completed in April 2012. The diagnosis of MCL was confirmed by our central histopathologic examination of pretherapeutic histological samples. The median overall survival (OS) was 47 months, median progression free survival (PFS) was 22 months. We demonstrated the influence of proliferative activity, MIPI and of the therapy type (intensive/non-intensive) on OS and PFS in univariate and multivariate analysis. Using univariate analysis we showed the prognostic influence of aggressive/other cytomorphological variants of MCL, nodal/extranodal localization of primary sample and also of the variants of MIPI - s-MIPI, MIPIb and a completely new variant of MIPI - combined MIPI. The prognostic influence of growth pattern and of the results of immunohistochemical reaction with CD23, CD5 and cyclin D1 antibodies were not confirmed. The other...

O linfoma de células do manto é associado à translocação t(11;14)(q13;q32) e à hiperexpressão da ciclina D1. Os pacientes com linfoma de células do manto apresentam-se com doença avançada ao diagnóstico e a fase leucêmica da doença é observada em cerca de um terço dos casos. Os linfócitos B virgens pré-centro germinativo, que ocupam a zona do manto dos folículos linfóides secundários, constituem a origem celular do linfoma de células do manto. A hiperexpressão da ciclina D1, por si só, não é suficiente para a patogênese da neoplasia, e a elucidação das alterações moleculares adicionais poderá fundamentar novas estratégias terapêuticas. Nesse contexto, os métodos de estudo do perfil de expressão gênica em larga escala têm potencial para auxiliar na descoberta dessas alterações moleculares adicionais. Todavia, nos estudos que empregaram esses métodos até o momento, o material genético foi obtido de amostras de gânglios acometidos pelo tumor, que contêm uma proporção variável de células normais do estroma do tecido linfóide. Por isso, ainda não se sabe quais dos genes identificados como alterados no linfoma de células do manto são específicos das células linfomatosas, e quais são dependentes das células normais que perfazem o estroma do gânglio. Com o objetivo de elucidar as alterações moleculares do linfoma de células do manto em nível celular, realizamos um estudo comparativo entre o perfil de expressão gênica de células linfomatosas purificadas e de linfócitos B virgens, utilizando microarrays de oligonucleotídeos. Células linfomatosas e linfócitos B virgens (IgD+CD38±CD27-) foram purificados em colunas magnéticas a partir do sangue periférico de pacientes com linfoma de células do manto em fase leucêmica e de amígdalas de indivíduos normais, respectivamente (pureza > 95%). Três indivíduos foram selecionados em cada grupo e os experimentos foram realizados em duplicatas usando microarrays comerciais modelo CodeLink Human UniSet I, com 10.000 genes. Foram identificados 106 genes com variação de expressão maior do que três vezes, 63 deles induzidos e 43 reprimidos no linfoma de células do manto em relação aos linfócitos B virgens. Dez genes (seis induzidos e quatro reprimidos) foram selecionados para quantificação, por RT-PCR em tempo real, em amostras de sangue periférico de 21 pacientes com linfoma de células do manto em fase leucêmica, além de 14 pacientes com outras doenças linfoproliferativas crônicas e de sete indivíduos sem doenças neoplásicas. Os resultados dos experimentos com microarrays foram confirmados pela quantificação por RT-PCR em tempo real em todos os 10 genes selecionados e os valores de expressão do gene TLR1 obtidos por esse método demonstraram correlação significativa com a sobrevida dos pacientes com linfoma de células do manto. Além de identificar vários genes modulados no linfoma de células do manto em nível celular, este estudo também revelou a expressão aberrante de diversos genes relacionados à apoptose e às vias de sinalização PI3K/AKT, WNT e TGFβ. Esses resultados adicionam informações originais à patogênese molecular do linfoma de células do manto e apontam para vias específicas de sinalização molecular como potenciais alvos para novas abordagens terapêuticas. / Mantle cell lymphoma is associated with the translocation t(11;14)(q13;32) and overexpression of cyclin D1. Mantle cell lymphoma is predominantly disseminated at diagnosis and a frank leukemic phase is detected in one third of patients. The pre-germinal-center naive B-cells, which populate the mantle zone of the secondary lymphoid follicles, are the cells of origin of mantle cell lymphoma. Overexpression of cyclin D1 is not sufficient by itself to cause lymphoma, and a better understanding of the additional molecular lesions may provide insights toward new therapeutic approaches. In this context, large scale gene expression studies may be useful in the investigation of such additional molecular lesions. However, the great majority of mantle cell lymphoma cases studied by these methods to date had the genetic material harvested from lymph nodes, which have a variable proportion of normal cells from the lymphoid stroma. It is therefore not known how many genes identified as differentially expressed in mantle cell lymphoma by tumor versus normal experiments are cell-autonomous rather than dependent on the tumor microenvironment. To address this issue, we compared the gene expression profile of mantle cell lymphoma cells and normal naive B-cells using oligonucleotide microarrays. Lymphoma cells and naive B-cells (IgD+CD38±CD27-) were highly purified, by magnetic activated cell sorting, from the peripheral blood of patients with mantle cell lymphoma in the leukemic phase and from tonsils of normal individuals, respectively (purity > 95% in all samples). Three individuals were selected for each group and experiments were performed in replicates using the Amersham CodeLink Human UniSet I Bioarrays, with 10,000 genes. We identified 106 genes differentially expressed with a fold change of at least three-fold, 63 induced and 43 repressed in mantle cell lymphoma in comparison with naive B-cells. Ten genes were selected (six induced and four repressed in lymphoma cells) for quantification by real-time RT-PCR in non-purified peripheral blood samples from 21 patients with mantle cell lymphoma in the leukemic phase, as well as in 14 patients with other chronic lymphoproliferative diseases and seven normal individuals. Microarray results were confirmed by real-time RT-PCR for all selected genes and expression values of the TLR1 gene as quantified by this method showed significant correlation with patient survival in mantle cell lymphoma. In addition to the identification of several modulated genes in mantle cell lymphoma at cellular level, this study revealed that some genes functionally connected through apoptosis or the PI3K/AKT, WNT and TGFβ signaling pathways are aberrantly expressed in mantle cell lymphoma. These results add original data to the molecular pathogenesis of mantle cell lymphoma and point to specific molecular signaling pathways related to inhibition of apoptosis as potential targets for new therapeutic approaches.

O linfoma de células do manto é associado à translocação t(11;14)(q13;q32) e à hiperexpressão da ciclina D1. Os pacientes com linfoma de células do manto apresentam-se com doença avançada ao diagnóstico e a fase leucêmica da doença é observada em cerca de um terço dos casos. Os linfócitos B virgens pré-centro germinativo, que ocupam a zona do manto dos folículos linfóides secundários, constituem a origem celular do linfoma de células do manto. A hiperexpressão da ciclina D1, por si só, não é suficiente para a patogênese da neoplasia, e a elucidação das alterações moleculares adicionais poderá fundamentar novas estratégias terapêuticas. Nesse contexto, os métodos de estudo do perfil de expressão gênica em larga escala têm potencial para auxiliar na descoberta dessas alterações moleculares adicionais. Todavia, nos estudos que empregaram esses métodos até o momento, o material genético foi obtido de amostras de gânglios acometidos pelo tumor, que contêm uma proporção variável de células normais do estroma do tecido linfóide. Por isso, ainda não se sabe quais dos genes identificados como alterados no linfoma de células do manto são específicos das células linfomatosas, e quais são dependentes das células normais que perfazem o estroma do gânglio. Com o objetivo de elucidar as alterações moleculares do linfoma de células do manto em nível celular, realizamos um estudo comparativo entre o perfil de expressão gênica de células linfomatosas purificadas e de linfócitos B virgens, utilizando microarrays de oligonucleotídeos. Células linfomatosas e linfócitos B virgens (IgD+CD38±CD27-) foram purificados em colunas magnéticas a partir do sangue periférico de pacientes com linfoma de células do manto em fase leucêmica e de amígdalas de indivíduos normais, respectivamente (pureza > 95%). Três indivíduos foram selecionados em cada grupo e os experimentos foram realizados em duplicatas usando microarrays comerciais modelo CodeLink Human UniSet I, com 10.000 genes. Foram identificados 106 genes com variação de expressão maior do que três vezes, 63 deles induzidos e 43 reprimidos no linfoma de células do manto em relação aos linfócitos B virgens. Dez genes (seis induzidos e quatro reprimidos) foram selecionados para quantificação, por RT-PCR em tempo real, em amostras de sangue periférico de 21 pacientes com linfoma de células do manto em fase leucêmica, além de 14 pacientes com outras doenças linfoproliferativas crônicas e de sete indivíduos sem doenças neoplásicas. Os resultados dos experimentos com microarrays foram confirmados pela quantificação por RT-PCR em tempo real em todos os 10 genes selecionados e os valores de expressão do gene TLR1 obtidos por esse método demonstraram correlação significativa com a sobrevida dos pacientes com linfoma de células do manto. Além de identificar vários genes modulados no linfoma de células do manto em nível celular, este estudo também revelou a expressão aberrante de diversos genes relacionados à apoptose e às vias de sinalização PI3K/AKT, WNT e TGFβ. Esses resultados adicionam informações originais à patogênese molecular do linfoma de células do manto e apontam para vias específicas de sinalização molecular como potenciais alvos para novas abordagens terapêuticas. / Mantle cell lymphoma is associated with the translocation t(11;14)(q13;32) and overexpression of cyclin D1. Mantle cell lymphoma is predominantly disseminated at diagnosis and a frank leukemic phase is detected in one third of patients. The pre-germinal-center naive B-cells, which populate the mantle zone of the secondary lymphoid follicles, are the cells of origin of mantle cell lymphoma. Overexpression of cyclin D1 is not sufficient by itself to cause lymphoma, and a better understanding of the additional molecular lesions may provide insights toward new therapeutic approaches. In this context, large scale gene expression studies may be useful in the investigation of such additional molecular lesions. However, the great majority of mantle cell lymphoma cases studied by these methods to date had the genetic material harvested from lymph nodes, which have a variable proportion of normal cells from the lymphoid stroma. It is therefore not known how many genes identified as differentially expressed in mantle cell lymphoma by tumor versus normal experiments are cell-autonomous rather than dependent on the tumor microenvironment. To address this issue, we compared the gene expression profile of mantle cell lymphoma cells and normal naive B-cells using oligonucleotide microarrays. Lymphoma cells and naive B-cells (IgD+CD38±CD27-) were highly purified, by magnetic activated cell sorting, from the peripheral blood of patients with mantle cell lymphoma in the leukemic phase and from tonsils of normal individuals, respectively (purity > 95% in all samples). Three individuals were selected for each group and experiments were performed in replicates using the Amersham CodeLink Human UniSet I Bioarrays, with 10,000 genes. We identified 106 genes differentially expressed with a fold change of at least three-fold, 63 induced and 43 repressed in mantle cell lymphoma in comparison with naive B-cells. Ten genes were selected (six induced and four repressed in lymphoma cells) for quantification by real-time RT-PCR in non-purified peripheral blood samples from 21 patients with mantle cell lymphoma in the leukemic phase, as well as in 14 patients with other chronic lymphoproliferative diseases and seven normal individuals. Microarray results were confirmed by real-time RT-PCR for all selected genes and expression values of the TLR1 gene as quantified by this method showed significant correlation with patient survival in mantle cell lymphoma. In addition to the identification of several modulated genes in mantle cell lymphoma at cellular level, this study revealed that some genes functionally connected through apoptosis or the PI3K/AKT, WNT and TGFβ signaling pathways are aberrantly expressed in mantle cell lymphoma. These results add original data to the molecular pathogenesis of mantle cell lymphoma and point to specific molecular signaling pathways related to inhibition of apoptosis as potential targets for new therapeutic approaches.

La voie PI3Kinase/AKT/mTOR, est une cible thérapeutique du temsirolimus, un inhibiteur de mTORC1. Dans le but d'obtenir une inhibition plus importante de cette voie j’utilise dans ce projet deux nouvelles molécules :- le NVP-BEZ 235 (BEZ) qui inhibe à la fois mTORC1 et la PI3kinase- l'AZD8055 (AZD), un inhibiteur des complexes mTORC1 et mTORC2. En utilisant différentes lignées de LCM, j’ai démontré que l'effet de ces nouveaux inhibiteurs sur la survie cellulaire est plus important que celui du temsirolimus. Cela est probablement dû à l'inhibition de la phosphorylation de l'AKT et la 4EBP. La deuxième partie de ce projet étudie la synergie entre les inhibiteurs de m-TOR kinase et l'aracytine. Un effet additif important a été démontré. J’ai trouvé en western blot que l’aracytine inhibe la phosphorylation des substrats de la voie Akt –mTOR notamment le 4EBP. L’ibrutinib (un inhibiteur de la voie Btk) a un effet modeste mais j’ai pu démontrer qu'il est capable à induire une inhibition plus importante de la survie cellulaire lorsqu'il est associé à l’aracytine. Cependant il s'est révélé antagoniste aux inhibiteurs de la voie PI3K-AKT-mTOR, cela reste difficile à décortiquer. Enfin, j’ai trouvé un effet additif de l’ibrutinib en combinaison avec la doxorubicine. Cependant les inhibiteurs de m-TOR n'ont pas le même effet. Afin d’expliquer ces résultats, j’ai étudié l’effet de ces molécules sur l’expression de GSTPi, enzyme de détoxification connue pour avoir un rôle important dans la résistance de LCM à l’anthracycline. J’ai mis en évidence une diminution de l’expression de cet enzyme par l’Ibrutinib. En revanche, les inhibiteurs de mTOR n’ont pas un effet sur l’expression de GSTPi. L’ibrutinib pourrait donc sensibiliser le LCM à l’anthracycline en diminuant l’expression de GSTPi. / The PI3K / AKT / mTOR pathway is the target of Temsirolimus. However, important resistance is observed. We tried to obtain a more important inhibition of PI3K / AKT pathway using two new molecules :- NVP-BEZ 235 (BEZ) which inhibits both mTORC1 and PI3K- AZD8055 (AZD) an inhibitor of mTORC1 and mTORC2 complexes. Using different cell lines of MCL, we have shown that the effect of these new inhibitors on cell survival was more important than that of Temsirolimus. This is probably because contrary to Temsirolimus, the two new molecules can inhibit AKT and 4EBP phosphorylation. In the second part of this project we studied the synergy between the m-TOR kinase inhibitors and aracytine (conventional treatment of MCL). We revealed a significant additive effect in MCL cell lines. We demonstrated by Western blot analysis that aracytine inhibits S6 and 4EBP phosphorylation. This may explain the results obtained from this drug association. We then showed that Ibrutinib (an inhibitor of Btk pathway) can induce a significant inhibition of cell survival when combined with aracytine. In this study, Ibrutinib proved antagonist effect to PI3K-AKT-mTOR inhibitors. The mechanisms of these results remain unclear. Finally, we demonstrated an additive effect of Ibrutinib in combination with doxorubicin. We did not obtain the same results when we combined m-TOR inhibitors with doxorubicin. To explain these data, we studied the effect of these drugs on the expression of GSTPi by western blot. This enzyme is known to have an important role in MCL resistance to anthracycline. Importantly, Ibrutinib induced a decrease in the expression of GSTPi but AZD8055, Temsirolimus and NVP-BEZ235 had no effect.

Le Lymphome à Cellules du Manteau (LCM) est une entité récemment identifiée qui se caractérise par la translocation génétique t(11 ;14)(q13 ;q32) et compte pour 2 à 10 % de tous les Lymphomes non-Hodgkiniens. Avec une survie médiane entre 3 et 5 ans après le diagnostic, le LCM est une pathologie agressive et malgré les récentes avancées thérapeutiques, peu d’informations sont disponibles concernant ses facteurs pronostiques. Certaines études ont analysé le rôle des caractéristiques clinicopathologiques et des nouvelles stratégies thérapeutiques, mais on connait peut le rôle des facteurs environnementaux et du mode de vie sur le pronostic des patients atteints de LCM. Entre 2008 et 2012, le groupe LYSA a mené en France deux essais cliniques prospectifs multicentriques : LM manteau 2010 SA "RiBVD" (NCI01457144) et Manteau 2007 SJ "LyMa" (NCT00921414). Après une comparaison de ces patients avec les patients de population générale, l’effet de facteurs socioéconomiques et des habitudes de vie sur la survie des patients a été étudié à l’aide d’un questionnaire qualitatif administré à tous les volontaires après le diagnostic. Nos résultats suggèrent qu’un faible niveau d’éducation, un indice de masse corporelle élevé et de la consommation d’alcool sont associés à un risque de décès plus élevé chez les patients atteints de LCM. Toutefois, l’étude de tels facteurs et de leur influence sur un sous-type de LNH aussi rare requiert des échantillons d’étude de taille plus importante. L’élargissement des critères d’inclusion des patients dans les essais cliniques permettrait de sélectionner davantage de patients mais aussi des patients mieux représentatifs de la population générale. Enfin, l’intégration systématique de ce type de questionnaire dans les protocoles d’essais cliniques serait aussi un atout majeur. / Mantle Cell Lymphoma (MCL) is a recently defined entity, typically characterised by the genetic translocation t(11 ;14)(q13 ;q32) and counting for 2 - 10% of all non-Hodgkin Lymphomas. With a median survival between 3 and 5 years after diagnosis, MCL is an agressive disease and despite the recent therapeutic advances little in know about its prognostic factors. Some studies had investigated clinicopathological features and new treatment strategies, but there is a lack of knowledge regarding the impact of lifestyle and environnemental factors on outcome of MCL patients. From 2008 to 2012, the LYSA Group conducted in France two prospective multi center clinical trials on MCL : LM manteau 2010 SA "RiBVD" (NCI01457144) and Manteau 2007 SJ "LyMa" (NCT00921414). After a comparison of these patients with population-based data, socioeconomic factors, lifestyle factors and their influence on survival had been investigated through a qualitative survey administrated to each volunteer after diagnosis. Our findings suggest that low educational attainment, low body body mass index and alcohol consumption are associated with a higher risk of death in MCL. However, to investigate lifestyle factors in this rare NHL subtype, larger studies should be carried out. Clinical trial inclusion criteria must be widen to select more patients and patients more representative of general population. Implementation of these epidemiological studies in clinical practice should be considered.

<p>Mantle cell lymphoma (MCL) is an aggressive B-cell malignancy with bad prognosis, which predominates in males with advanced age. However, studies of the endocannabinoid system and how it affects tumour behaviour provides the basis for designing innovative therapeutic strategies that could open new opportunities for treatment of patient with MCL. It has earlier been shown that the cannabinoid receptor ligand (R)-(+)-methanandamide (R-MA) induce cell death in MCL by accumulation of ceramide. Ceramide has a pro-apoptotic effect on the cell but could be metabolized by the enzymes glucosylceramide synthase (GCS) and sphingosine kinase 1 (SphK1) to molecules with pro-proliferative effect. Therefore, treatments with R-MA on Jeko-1 MCL cell line were performed in this study to determine interference in the proliferative behaviour as well as in the gene expression of the enzymes GCS and SphK1. In addition, treatments with chemotherapeutic substances, such as doxorubicin or cytarabine (Ara-C), and combinations of R-MA and chemotherapeutic substance, were performed for the same reason. Results showed that the proliferation behaviour of Jeko cells remained unaffected when treated with R-MA, in contrast to the decreased proliferative effects shown when treated with cytostatics or combinations of R-MA and cytostatics. Furthermore, a tendency for up-regulation of GCS and SphK1 expression was recognized when cells were treated with cytostatics or combination of cytostatics and R-MA, in contrast to cells treated with R-MA alone. Although, R-MA alone had a tendency for a small down-regulation of GCS expression, it contributed to a potential elevation of GCS expression when combined with Ara-C or doxorubicin. It is believed that the effect from upregulated levels of the metabolizing enzymes GCS and SphK1 is balanced by, earlier observed, up-regulations of the ceramide synthesis enzymes.</p>

<p>B cell lymphomas and leukemias are heterogeneous tumors with different cellular origins. Analysis of immunoglobulin (Ig) genes enables insight into the B cell progenitor, as Ig somatic hypermutation correlates with antigen-related B cell transit through the germinal center (GC). Also, restricted Ig variable heavy chain (V_H) gene repertoires in B cell malignancies could imply antigen selection during tumorigenesis. The length of telomeres has been shown to differ between GC B cells and pre/post-GC B cells, possibly representing an alternative angle to investigate B cell tumor origin. </p><p>Mantle cell lymphoma (MCL), previously postulated to derive from a naïve, pre-GC B cell, was shown to have an Ig-mutated subset (18/110 MCLs, 16%), suggestive of divergent cellular origin and GC exposure. Another subset of MCL (16/110, 15%), characterized by V_H3-21/V_λ3-19 gene usage, alludes to a role for antigen(s) in pathogenesis, also possible for hairy cell leukemia (HCL) in which the V_H3-30 gene (6/32, 19%) was overused. HCL consisted mainly of Ig-mutated cases (27/32, 84%) with low level intraclonal heterogeneity, contrasting with the proposed post-GC origin, for both Ig-mutated and Ig-unmutated HCLs. For MCL and HCL, derivation from naïve or memory marginal zone B cells which may acquire mutations without GC transit are tempting speculations, but currently little is known about this alternative immunological pathway. Heavily mutated Ig genes without intraclonal heterogeneity were demonstrated in lymphoplasmacytic lymphoma/Waldenström’s macroglobulinemia (13/14, 93%), confirming that the precursor cell was transformed after GC affinity maturation. Telomere length analysis within 304 B cell tumors revealed variable lengths; shortest in the Ig-unmutated subset of chronic lymphocytic leukemia, longest in the GC-like subtype of diffuse large B cell lymphoma, and homogeneous in MCL regardless of Ig mutation status. However, telomere length is complex with regard to GC-related origin.</p><p>In summary, this thesis has provided grounds for speculation that antigens play a role in MCL and HCL pathogenesis, although the potential antigens involved are currently unknown. It has also enabled a more informed postulation about the cellular origin of B cell tumors, which will ultimately enhance understanding of the biological background of the diseases. </p>

B cell lymphomas and leukemias are heterogeneous tumors with different cellular origins. Analysis of immunoglobulin (Ig) genes enables insight into the B cell progenitor, as Ig somatic hypermutation correlates with antigen-related B cell transit through the germinal center (GC). Also, restricted Ig variable heavy chain (VH) gene repertoires in B cell malignancies could imply antigen selection during tumorigenesis. The length of telomeres has been shown to differ between GC B cells and pre/post-GC B cells, possibly representing an alternative angle to investigate B cell tumor origin. Mantle cell lymphoma (MCL), previously postulated to derive from a naïve, pre-GC B cell, was shown to have an Ig-mutated subset (18/110 MCLs, 16%), suggestive of divergent cellular origin and GC exposure. Another subset of MCL (16/110, 15%), characterized by VH3-21/Vλ3-19 gene usage, alludes to a role for antigen(s) in pathogenesis, also possible for hairy cell leukemia (HCL) in which the VH3-30 gene (6/32, 19%) was overused. HCL consisted mainly of Ig-mutated cases (27/32, 84%) with low level intraclonal heterogeneity, contrasting with the proposed post-GC origin, for both Ig-mutated and Ig-unmutated HCLs. For MCL and HCL, derivation from naïve or memory marginal zone B cells which may acquire mutations without GC transit are tempting speculations, but currently little is known about this alternative immunological pathway. Heavily mutated Ig genes without intraclonal heterogeneity were demonstrated in lymphoplasmacytic lymphoma/Waldenström’s macroglobulinemia (13/14, 93%), confirming that the precursor cell was transformed after GC affinity maturation. Telomere length analysis within 304 B cell tumors revealed variable lengths; shortest in the Ig-unmutated subset of chronic lymphocytic leukemia, longest in the GC-like subtype of diffuse large B cell lymphoma, and homogeneous in MCL regardless of Ig mutation status. However, telomere length is complex with regard to GC-related origin. In summary, this thesis has provided grounds for speculation that antigens play a role in MCL and HCL pathogenesis, although the potential antigens involved are currently unknown. It has also enabled a more informed postulation about the cellular origin of B cell tumors, which will ultimately enhance understanding of the biological background of the diseases.

Mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL) both belong to the group of mature B-cell malignancies. However, MCL is typically clinically aggressive while the clinical course of CLL varies. CLL can be divided into prognostic subgroups based on IGHV mutational status and into multiple subsets based on closely homologous (stereotyped) B-cell receptors. In paper I we investigated 31 MCL cases using high-density 250K single-nucleotide polymorphism arrays and gene expression arrays. Although most copy-number aberrations (CNAs) were previously reported in MCL, a novel deletion was identified at 20q (16%) containing the candidate tumor suppressor gene ZFP64. A high proliferation gene expression signature was associated with poor prognosis, large CNAs, 7p gains and 9q losses. Losses at 1p/8p/13q/17p were associated with increased genomic complexity. In paper II we sequenced exons 4 to 8 of the TP53 gene in 119 MCL cases. 17p copy-number status was known from previous studies or determined by real-time quantitative polymerase chain reaction. TP53 mutations were detected in 14% of cases and were strongly associated with poor survival while 17p deletions were more common (32%) but did not predict survival. In papers III and IV we applied high-resolution genomic 27K methylation arrays to 20 MCL and 39 CLL samples. In paper III MCL displayed a homogenous methylation profile without correlation with the proliferation signature whereas MCL was clearly separated from CLL. Gene ontology analysis revealed enrichment of developmental genes, in particular homeobox transcription factor genes, among targets methylated in MCL. In paper IV we compared three different stereotyped CLL subsets: #1 (IGHV unmutated), #2 (IGHV3-21) and #4 (IGHV mutated). Many genes were differentially methylated between each two subsets and immune response genes (e.g. CD80 and CD86) were enriched among genes methylated in subset #1 but not in subsets #2/#4. In summary, CNAs were frequent and not random in MCL. Specific CNAs correlated with a high proliferation gene expression signature or genomic complexity. TP53 mutations predicted short survival whereas 17p deletions did not. A high proliferation signature was not associated with differential DNA methylation in MCL, which demonstrated a homogeneous methylation pattern. In contrast, genomic methylation patterns differed between MCL and CLL and between stereotyped CLL subsets.