Genetic abnormalities as diagnostic and prognostic markers in B cell lymphomas: role of new molecular technologies in personalized medicine for extranodal diffuse large B cell lymphoma (EN-DLBCL) and follicular lymphoma (FL)

A plethora of molecular biomarkers are available nowadays in the field of cancer research. However, it is crucial to understand when and how they can be integrated into the clinical setting, translating experimental results from bench to bedside, with the aim of improving patients’ care. We decided to investigate the role of some of these biomarkers in two subtypes of non-Hodgkin lymphoma which still represent a challenge for both researchers and clinicians. We started from diffuse large B cell lymphomas (DLBCLs), investigating a multicentric series of primary extranodal DLBCLs. Overall, data analysis provided strong evidence that the distribution of immunophenotypic, cytogenetic and survival characteristics is site-dependent. We next moved to follicular lymphoma (FL). The translocation (14;18), leading to BCL2 protein overexpression, is considered the genetic hallmark of FL. We tested the incidence of BCL2 negative FLs in a series of Italian patients from the Insubric region, concluding that BCL2 rearrangement in FL is not as frequent as generally reported and that the genetic landscape of FL is more complex than previously thought. What we learned is that even within an individual clinical entity, there is considerable heterogeneity with respect to genetic alterations, expression of commonly assayed markers and, most important, outcome. The personalized approach acknowledges this complexity and gives us tools for the continuous improvement of patients’ care.