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Blood, 9 April 2009, Vol. 113, No. 15, pp. 3553-3557. Prepublished online as a Blood First Edition Paper on February 6, 2009; DOI 10.1182/blood-2008-08-174839.
LYMPHOID NEOPLASIA Transformation of follicular lymphoma to diffuse large B-cell lymphoma may occur by divergent evolution from a common progenitor cell or by direct evolution from the follicular lymphoma clone1 Centre for Medical Oncology Laboratory, Barts and The London School of Medicine and Dentistry, London, United Kingdom; 2 Department of Medicine, University of Alberta and Cross Cancer Institute, Edmonton, AB; and 3 Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB To investigate the cell of origin linking follicular (FL) and transformed (t-FL) lymphomas, we analyzed the somatic hypermutation (SHM) pattern of the variable region of the immunoglobulin heavy gene (IgH-VH) in 18 sequential FL/t-FL samples and a father (donor) and son (recipient), who developed FL and t-FL, after transplantation. Genealogic trees showed a pattern compatible with a common progenitor cell (CPC) origin in 13 cases. The identification of the t-FL clonotype in the previous FL sample and of the putative CPC sequence in both the FL/t-FL biopsies showed that the intraclonal diversity of FL and t-FL germinal centers (GCs) is more intricate than previously described, and all 3 clonotypes (CPC, FL, t-FL) may occur simultaneously within the same lymph node. On the basis of the father/son model, this CPC must be long-lived, providing a possible explanation for the incurable nature of this disease.
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