Key Points

  • Genetic alterations in immune checkpoint-related genes are frequent in IVLBCL.

  • Plasma cell-free DNA is an alternative tumor DNA source of IVLBCL to detect genetic alterations by comprehensive analyses.

Intravascular large-B-cell lymphoma (IVLBCL) is a unique type of extranodal lymphoma characterized by selective growth of tumor cells in small vessels without lymphadenopathy. Greater understanding of the molecular pathogenesis of IVLBCL is hampered by the paucity of lymphoma cells in biopsy specimens, creating a limitation in obtaining sufficient tumor materials. To uncover the genetic landscape of IVLBCL, we performed whole-exome sequencing (WES) of 21 patients with IVLBCL using plasma-derived cell-free DNA (cfDNA) (n = 18), patient-derived xenograft tumors (n = 4), and tumor DNA from bone marrow (BM) mononuclear cells (n = 3). The concentration of cfDNA in IVLBCL was significantly higher than that in diffuse large-B-cell lymphoma (DLBCL) (P < 0.0001) and healthy donors (P = 0.0053), allowing us to perform WES, and most mutations detected in BM tumor DNA were successfully captured in cfDNA and xenograft. IVLBCL showed a high frequency of genetic lesions characteristic of activated-B-cell-type DLBCL; with the former showing conspicuously higher frequencies (compared to nodal DLBCL) of mutations in MYD88 (57%), CD79B (67%), SETD1B (57%), and HLA-B (57%). We also found that 8 (38%) IVLBCL harbored rearrangements of PD-L1/PD-L2 involving the 3′-UTR; such rearrangements are implicated in immune evasion via PD-L1/PD-L2 overexpression. Our data demonstrate the utility of cfDNA and imply important roles for immune evasion in IVLBCL pathogenesis and PD-1/PD-L1/PD-L2 blockade in therapeutics for IVLBCL.

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