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A tenet of cancer biology is that a single transformed cell gives rise to subclones of daughter cells of varying malignant potential and chemosensitivity. To better understand this clonal evolution, investigators performed whole-genome sequencing of bone marrow acute myeloid leukemia (AML) cells in seven patients with secondary AML as well as parallel sequencing of normal (skin) DNA and precursor myelodysplastic syndrome (MDS) marrow cells. The analysis included patients with both normal and complex cytogenetics.
A foundational clone was present in each case, with the mutations in the MDS clone preserved within the AML cells, plus numerous additional mutations. About 85% of the marrow cells were clonal, regardless of the percentage of myelob…