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Environmental or self-antigens and homotypic interactions result in BCR and Toll-like receptor (TLR) signaling, amplifying the reaction of CLL cells to other alerts in the microenvironment and raising the activation of anti-apoptotic and proliferation pathways.31,32 Genomic scientific tests have identified recurrent mutations in genes regulating tumor cell-microenvironment interactions, which happen to be already necessary for tumor mobile expansion. Consequently, NOTCH1 mutations are dependent on the existence of Notch ligands inside the microenvironment and activate procedures like mobile migration, invasion and angiogenesis.

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