Impact des anomalies moléculaires dans l'histoire naturelle de la leucémie lymphoïde chronique

Abstract : Chronic lymphocytic leukemia (CLL) is the most frequent lymphoma with leukemic phase in the elderly in Western countries. It is characterized by a great heterogeneity in its natural history with indolent forms never requiring any specific treatment and aggressive forms needing chemotherapy rapidly after diagnosis. In this work of thesis, we asked the question of the role of molecular abnormalities, and in particular of the immunoglobulin genes in the natural history of the disease, at mechanistic level and for prognosis. We studied three atypical rearrangements implicating an immunoglobulin gene and an unknown partner in CLL/lymphocytic lymphoma. The breakpoints have been identified and the implication of long non coding RNA was highlighted in two cases in 17q25 and 8q24. Moreover, two cases harboured breakpoints in a restricted chromosomic region (200 kb spaced in 17q25). It could be an important locus in lymphomagenesis, as is 8q24 region containing MYC and numerous other non coding genes poorly characterized by now. Furthermore, in high throughput sequencing (HTS) era, many molecular prognosis markers have been described in CLL. We demonstrated that normal serum protein electrophoresis (polyclonal immunoglobulin without hypogammaglobulinemia) at diagnosis, a simple and unexpensive marker, stays in HTS era an independent good prognosis marker in CLL. Its combination with unmutated IGHV genes status identifies a group of patients who will probably never require any specific treatment. This work led us to develop an efficient tool to detect copy number variations by THS. This tool allows to highlight uniparental disomy whose prognosis signification is not established in CLL. These abnormalities could reflect chromosomal instability and it could be interesting to study their prognosis impact in CLL.
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Jasmine Chauzeix. Impact des anomalies moléculaires dans l'histoire naturelle de la leucémie lymphoïde chronique. Médecine humaine et pathologie. Université de Limoges, 2018. Français. ⟨NNT : 2018LIMO0051⟩. ⟨tel-02405662⟩

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