Targeting the immune microenvironment in Waldenström Macroglobulinemia via halting the CD40/CD40-ligand axis

• - A CD40/CD40-ligand interaction mediates WM-to-Treg cell cross-talk.

• - Blocking the CD40/CD40-ligand axis inhibits Treg-mediated immunosuppression and reduces WM cell growth.

Recent investigations have improved our understanding of the molecular aberrations supporting Waldenström Macroglobulinemia (WM) biology; however, whether the immune microenvironment contributes to WM pathogenesis remains unanswered. We first showed how a transgenic murine model of human-like lymphoplasmacytic lymphoma/WM exhibits an increased number of regulatory T (Treg) cells with respect to control mice. These findings were translated into the WM clinical setting, where the transcriptomic profiling of WM patients'-derived regulatory T cells (Tregs) unveiled a peculiar WM-devoted mRNA signature, with significant enrichment for NF-kB-mediated TNF-a signaling-, MAPK-, PI3K/AKT-related genes; paralleled by different Treg functional phenotype. We demonstrated a significantly higher Treg-induction, -expansion and -proliferation triggered by WM cells as compared to their normal cellular counterpart; with a more profound effect within the context of CXCR4^C1013G-mutated WM cells. By investigating the B-to-T cell cross-talk at single-cell level, we identified the CD40/CD40-ligand as a potentially relevant axis supporting WM cell-Treg cell interaction. Our findings demonstrate the existence of a Treg-mediated immunosuppressive phenotype in WM, which can be therapeutically reversed by blocking the CD40L/CD40 axis to inhibit WM cell growth.