MYC chromosomal rearrangements (
MYC-R) occur in 10% to 15% of
diffuse large B-cell lymphoma (DLBCLs), an aggressive
Non-Hodgkin Lymphoma (NHL). Patients with
MYC-R have inferior outcomes and can be classified as single-hit, when they only have
MYC-R; as double hit when the rearrangement is accompanied by a translocation of
BCL2 or
BCL6; and as triple hit when
MYC-R includes both
BCL2 and
BCL6. Double and triple hit lymphoma have been recently classified as high-grade B-cell lymphoma (HGBCL) and it is associated with a poor prognosis.
MYC-R in DLBCL/HGBCL is believed to arise through the aberrant activity of activation-induced cytidine deaminase (AICDA), which facilitates somatic hypermutation (SHM) and class-switch recombination (CSR). Although AICDA primarily targets IG loci for SHM and CSR, its off-target mutagenic effects can impact lymphoma-associated oncogenes like
MYC, potentially leading to oncogenic rearrangements. The breakpoints in
MYC rearrangements show considerable variability within the
MYC region. These breakpoints may occur within the so-called "genic cluster," a region spanning approximately 1.5 kb upstream of the transcription start site, as well as the first exon and intron of
MYC.
Fluorescence in situ hybridization (FISH) has become a routine practice in many clinical laboratories for lymphoma characterization. A break-apart (BAP) FISH probe is commonly utilized for the detection of
MYC-R due to the variability of breakpoints in the
MYC locus and the diversity of rearrangement partners, including immunoglobulin (IG) and non-IG partners (i.e.
BCL2/
BCL6). The
MYC BAP probe includes a red and a green probe which hybridize 5' and 3' to the
MYC gen, respectively. In an intact
MYC locus, these probes yield a fusion signal. When
MYC-R occur, two types of signals can be observed: • Balanced patterns: These patterns present separate red and green signals. • Unbalanced patterns: When isolated red or green signals in the absence of the corresponding green or red signal is observed. Unbalanced
MYC-R are frequently associated with increased
MYC expression. There is a large variability in the interpretation of unbalanced
MYC BAP results among the scientists, which can impact diagnostic classification and therapeutic management of the patients. == Animal models ==