- Lazarian, Gregory;
- Yin, Shanye;
- Ten Hacken, Elisa;
- Sewastianik, Tomasz;
- Uduman, Mohamed;
- Font-Tello, Alba;
- Gohil, Satyen H;
- Li, Shuqiang;
- Kim, Ekaterina;
- Joyal, Heather;
- Billington, Leah;
- Witten, Elizabeth;
- Zheng, Mei;
- Huang, Teddy;
- Severgnini, Mariano;
- Lefebvre, Valerie;
- Rassenti, Laura Z;
- Gutierrez, Catherine;
- Georgopoulos, Katia;
- Ott, Christopher J;
- Wang, Lili;
- Kipps, Thomas J;
- Burger, Jan A;
- Livak, Kenneth J;
- Neuberg, Donna S;
- Baran-Marszak, Fanny;
- Cymbalista, Florence;
- Carrasco, Ruben D;
- Wu, Catherine J
Hotspot mutation of IKZF3 (IKZF3-L162R) has been identified as a putative driver of chronic lymphocytic leukemia (CLL), but its function remains unknown. Here, we demonstrate its driving role in CLL through a B cell-restricted conditional knockin mouse model. Mutant Ikzf3 alters DNA binding specificity and target selection, leading to hyperactivation of B cell receptor (BCR) signaling, overexpression of nuclear factor κB (NF-κB) target genes, and development of CLL-like disease in elderly mice with a penetrance of ~40%. Human CLL carrying either IKZF3 mutation or high IKZF3 expression was associated with overexpression of BCR/NF-κB pathway members and reduced sensitivity to BCR signaling inhibition by ibrutinib. Our results thus highlight IKZF3 oncogenic function in CLL via transcriptional dysregulation and demonstrate that this pro-survival function can be achieved by either somatic mutation or overexpression of this CLL driver. This emphasizes the need for combinatorial approaches to overcome IKZF3-mediated BCR inhibitor resistance.