The hunt for biomarkers for anti-VEGF agent bevacizumab is ongoing since last decade with no success. Identifying robust biomarkers for stratifying patients and for monitoring response is important for the future use of bevacizumab in breast cancer. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) analysis and genome wide gene expression analysis are two promising approaches to understand the molecular mechanisms and search for biomarker of anti-angiogenic therapy. Firstly, with the retrospective pilot study, a close link between DCE-MRI findings and the molecular mechanisms assisting cancer survival and metastasis was established. Secondly, the prospective window of opportunity study conducted using single cycle of bevacizumab given before neoadjuvant chemotherapy and by performing detailed pharmacodynamic analyses with DCE-MRI and gene expression before and two weeks after bevacizumab had shown a wide variation in responses to bevacizmab both at genomic and imaging level. A close link between changes in DCE-MRI and the changes in gene expression profile was further established suggesting DCE-MRI has potential to serve as non-invasive biomarkers of antiangiogenic therapy. Tumours with high baseline values of forward transfer constant K^trans showed the maximum response as assessed by DCE-MRI after bevacizumab. By performing biopsy after single cycle of bevacizumab, the changes in genes related to immune response, metabolism and cell signalling were observed that gives a useful insight into mechanisms governing response and resistance to bevacizumab. Also the certain gene expression changes observed with post bevacizumab biopsies, such as down regulation of endothelial cell specific molecule-1 (ESM1), cyclin E1 (CCNE1) and up regulation of pyruvate dehydrogenase kinase 1 (PDK1), cyclic GMP-inhibited phosphodiesterase B (PDE3B) could be helpful in decision-making about future therapy with bevacizumab at an early stage. This study has suggested that using bevacizumab in combination with other targeted agents could overcome resistance.

In chronic lymphocytic leukemia (CLL), the presence of multiple subsets expressing ‘stereotyped’ B-cell receptors (BCRs) has implicated antigen(s) in leukemogenesis. These stereotyped subsets display similar immunoglobulin (IG) gene usage, almost identical complementarity determining region 3’s and may share clinical features. For instance, subsets #1 (IGHV1/5/7/IGKV1-39) and #2 (IGHV3-21/IGLV3-21) have inferior outcome compared to non-subset patients, whereas subset #4 (IGHV4-34/IGKV2-30) display a favourable prognosis. The aim of this thesis was to investigate genomic aberrations, gene expression patterns and methylation profiles in stereotyped subsets and compare epigenetic profiles in CLL and mantle cell lymphoma (MCL). In paper I, we investigated genomic aberrations in subsets #2, #4 and #16 and in non-stereotyped samples (n=101) using high-density 250K SNP arrays. Subset #2 and non-subset #2 IGHV3-21 cases displayed a higher frequency of aberrations than subset #4 cases. The high incidence of del(11q) in both subset #2/non-subset #2 may reflect the adverse survival reported for IGHV3-21 patients. In contrast, the lower frequency of genetic events and lack of poor-prognostic aberrations in subset #4 may partially explain their indolent disease. In paper II, we analysed the global RNA expression in subset #4, #16 and non-subset IGHV4-34 CLL patients (n=25). Subsets #4 and 16 showed distinct gene expression profiles, where genes involved in cell regulatory pathways were significantly lower expressed in subset #4, in line with their low-proliferative disease. In paper III, a genome-wide methylation array was applied to investigate methylation profiles in subsets #1, #2 and #4 (n=39). We identified differential methylation patterns for all subsets and found affected genes to be involved in e.g. apoptosis and therapy resistance. When performing functional annotation, a clear enrichment of genes involved in adaptive immunity was observed. These genes were preferentially methylated in subset #1 when compared to either subset #2 or #4, possibly due to different antigen responses. In paper IV, the genome-wide methylation profiles for 30 CLL and 20 MCL patients were investigated. Distinct methylation profiles were observed, where MCL displayed a more homogeneous profile. Homeobox transcription factor genes showed a higher degree of methylation in MCL, while apoptosis-related genes and proliferation-associated genes were methylated in CLL. In summary, this thesis demonstrates that stereotyped CLL subsets display differences in gene expression profiles, genetic aberrations and methylation patterns, underscoring the functional relevance of subgrouping according to BCR stereotypy. The distinct methylation profiles of CLL and MCL suggests that different epigenetic mechanisms are involved in the pathogenesis of these B-cell malignancies.