Exploiting Synthetic Lethality for the Therapy of ABC Diffuse Large B Cell Lymphoma

SummaryKnowledge of oncogenic mutations can inspire therapeutic strategies that are synthetically lethal, affecting cancer cells while sparing normal cells. Lenalidomide is an active agent in the activated B cell-like (ABC) subtype of diffuse large B cell lymphoma (DLBCL), but its mechanism of action is unknown. Lenalidomide kills ABC DLBCL cells by augmenting interferon β (IFNβ) production, owing to the oncogenic MYD88 mutations in these lymphomas. In a cereblon-dependent fashion, lenalidomide downregulates IRF4 and SPIB, transcription factors that together prevent IFNβ production by repressing IRF7 and amplify prosurvival NF-κB signaling by transactivating CARD11. Blockade of B cell receptor signaling using the BTK inhibitor ibrutinib also downregulates IRF4 and consequently synergizes with lenalidomide in killing ABC DLBCLs, suggesting attractive therapeutic strategies.

► Lenalidomide kills ABC DLBCLs by decreasing expression of IRF4 and SPIB
► IRF4 and SPIB maintain ABC DLBCL viability
► IRF4 and SPIB block toxic IFNβ production while enhancing prosurvival NF-κB activity
► Lenalidomide and BCR pathway drugs synergize to inhibit IRF4 and kill ABC DLBCLs