Waldenström Macroglobulinemia Whole Genome Reveals Prolonged Germinal Center Activity and Late Copy Number Aberrations.

The genomic landscape of Waldenström Macroglobulinemia (WM) is characterized by somatic mutations in MYD88, present from the precursor stages. Using the comprehensive resolution of whole genome sequencing (WGS) in 14 CD19-selected primary WM samples; comparing clonal and subclonal mutations revealed that germinal center mutational signatures SBS9 (poly-eta) and SBS84 (AID) have sustained activity, suggesting that the interaction between WM and the germinal center continues over time. Expanding our cohort size with 33 targeted sequencing samples, we interrogated the WM copy number alteration (CNA) landscape and chronology. Interestingly, CNA prevalence progressively increases in symptomatic WM and relapsed disease when comparing to stable precursor stages, with stable precursors lacking genomic complexity. Two MYD88 wild type WGS contained a clonal gain affecting chromosome 12, which is typically an early event in chronic lymphocytic leukemia. Molecular time analysis demonstrated that both chromosomal 12 gain events occurred early in cancer development while other CNA changes tend to occur later in the disease course and are often subclonal. In summary, WGS analysis in WM allows the demonstration of sustained germinal center activity over time and allows the reconstruction of the temporal evolution of specific genomic features. In addition, our data suggests that, while MYD88-mutations are central to WM clone establishment and can be observed in precursor disease, CNA may contribute to later phases, and may be used as a biomarker for progression risk from precursor conditions to symptomatic disease.