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Historically, germline predisposition was thought to primarily affect the young. However, emerging data indicate that hematopoietic malignancies that develop in people of all ages across the human lifespan can derive from germline predisposing conditions and are not exclusively observed in younger individuals. The age at which hematopoietic malignancies manifest appears to correlate with distinct underlying biological pathways. Progression from having a deleterious germline variant to being diagnosed with overt malignancy involves complex, multistep gene\u2013environment interactions with key external triggers, such as infection and inflammatory stimuli, driving clonal progression. Understanding the mechanisms by which predisposed clones transform under specific pressures may reveal strategies to better treat and even prevent hematopoietic malignancies from occurring.<\/jats:p>\n                  <jats:p>Recent unbiased genome-wide sequencing studies of children and adults with hematopoietic malignancies have revealed novel genes in which disease-causing variants are of germline origin. This paradigm shift is spearheaded by findings in myelodysplastic syndrome\/acute myeloid leukemia (MDS\/AML) as well as acute lymphoblastic leukemia, but it also encompasses other cancer types. Although not without challenges, the field of genetic cancer predisposition is advancing quickly, and a better understanding of the genetic basis of hematopoietic malignancies risk affects therapeutic decisions as well as genetic counseling and testing of at-risk family members.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1158\/2159-8290.cd-23-1091","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T11:30:42Z","timestamp":1709292642000},"page":"396-405","update-policy":"https:\/\/doi.org\/10.1158\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Insights into the Molecular Mechanisms of Genetic Predisposition to Hematopoietic Malignancies: The Importance of Gene\u2013Environment Interactions"],"prefix":"10.1158","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3807-9204","authenticated-orcid":false,"given":"Cesar","family":"Cobaleda","sequence":"first","affiliation":[{"name":"1Immune System Development and Function Unit, Centro de Biolog\u00eda Molecular Severo Ochoa (CBM, CSIC-UAM), Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1914-9158","authenticated-orcid":false,"given":"Lucy A.","family":"Godley","sequence":"additional","affiliation":[{"name":"2Division of Hematology\/Oncology, Department of Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5581-6555","authenticated-orcid":false,"given":"Kim E.","family":"Nichols","sequence":"additional","affiliation":[{"name":"3Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6638-9643","authenticated-orcid":false,"given":"Marcin W.","family":"Wlodarski","sequence":"additional","affiliation":[{"name":"4Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6989-9905","authenticated-orcid":false,"given":"Isidro","family":"Sanchez-Garcia","sequence":"additional","affiliation":[{"name":"5Experimental Therapeutics and Translational Oncology Program, 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