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Clonal evolution in leukemia
Nature Medicinevolume 23, pages1135–1145 (2017)Cite this article
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Abstract
Human leukemias are liquid malignancies characterized by diffuse infiltration of the bone marrow by transformed hematopoietic progenitors. The accessibility of tumor cells obtained from peripheral blood or through bone marrow aspirates, together with recent advances in cancer genomics and single-cell molecular analysis, have facilitated the study of clonal populations and their genetic and epigenetic evolution over time with unprecedented detail. The results of these analyses challenge the classic view of leukemia as a clonal homogeneous diffuse tumor and introduce a more complex and dynamic scenario. In this review, we present current concepts on the role of clonal evolution in lymphoid and myeloid leukemia as a driver of tumor initiation, disease progression and relapse. We also discuss the implications of these concepts in our understanding of the evolutionary mechanisms involved in leukemia transformation and therapy resistance.
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References
Nowell, P.C. The clonal evolution of tumor cell populations.Science194, 23–28 (1976).
Merlo, L.M., Pepper, J.W., Reid, B.J. & Maley, C.C. Cancer as an evolutionary and ecological process.Nat. Rev. Cancer6, 924–935 (2006).
Burrell, R.A., McGranahan, N., Bartek, J. & Swanton, C. The causes and consequences of genetic heterogeneity in cancer evolution.Nature501, 338–345 (2013).
Greaves, M. Evolutionary determinants of cancer.Cancer Discov.5, 806–820 (2015).
Puente, X.S. & López-Otín, C. The evolutionary biography of chronic lymphocytic leukemia.Nat. Genet.45, 229–231 (2013).
Landau, D.A., Carter, S.L., Getz, G. & Wu, C.J. Clonal evolution in hematological malignancies and therapeutic implications.Leukemia28, 34–43 (2014).
Greaves, M. Leukaemia 'firsts' in cancer research and treatment.Nat. Rev. Cancer16, 163–172 (2016).
Dick, J.E. Stem cell concepts renew cancer research.Blood112, 4793–4807 (2008).
Jan, M. & Majeti, R. Clonal evolution of acute leukemia genomes.Oncogene32, 135–140 (2013).
Malkin, D. et al. Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas, and other neoplasms.Science250, 1233–1238 (1990).
Song, W.J. et al. Haploinsufficiency of CBFA2 causes familial thrombocytopenia with propensity to develop acute myelogenous leukaemia.Nat. Genet.23, 166–175 (1999).
Smith, M.L., Cavenagh, J.D., Lister, T.A. & Fitzgibbon, J. Mutation of CEBPA in familial acute myeloid leukemia.N. Engl. J. Med.351, 2403–2407 (2004).
Hahn, C.N. et al. Heritable GATA2 mutations associated with familial myelodysplastic syndrome and acute myeloid leukemia.Nat. Genet.43, 1012–1017 (2011).
Noris, P. et al. ANKRD26-related thrombocytopenia and myeloid malignancies.Blood122, 1987–1989 (2013).
Polprasert, C. et al. Inherited and somatic defects in DDX41 in myeloid neoplasms.Cancer Cell27, 658–670 (2015).
Shah, S. et al. A recurrent germline PAX5 mutation confers susceptibility to pre-B cell acute lymphoblastic leukemia.Nat. Genet.45, 1226–1231 (2013).
Zhang, M.Y. et al. Germline ETV6 mutations in familial thrombocytopenia and hematologic malignancy.Nat. Genet.47, 180–185 (2015).
Moriyama, T. et al. Germline genetic variation in ETV6 and risk of childhood acute lymphoblastic leukaemia: a systematic genetic study.Lancet Oncol.16, 1659–1666 (2015).
Greaves, M.F., Maia, A.T., Wiemels, J.L. & Ford, A.M. Leukemia in twins: lessons in natural history.Blood102, 2321–2333 (2003).
Sanjuan-Pla, A. et al. Revisiting the biology of infant t(4;11)/MLL-AF4+ B-cell acute lymphoblastic leukemia.Blood126, 2676–2685 (2015).
Hong, D. et al. Initiating and cancer-propagating cells in TEL-AML1-associated childhood leukemia.Science319, 336–339 (2008).
Greaves, M. Infection, immune responses and the aetiology of childhood leukaemia.Nat. Rev. Cancer6, 193–203 (2006).
Jacobs, K.B. et al. Detectable clonal mosaicism and its relationship to aging and cancer.Nat. Genet.44, 651–658 (2012).
Laurie, C.C. et al. Detectable clonal mosaicism from birth to old age and its relationship to cancer.Nat. Genet.44, 642–650 (2012).
Genovese, G. et al. Clonal hematopoiesis and blood-cancer risk inferred from blood DNA sequence.N. Engl. J. Med.371, 2477–2487 (2014).
Jaiswal, S. et al. Age-related clonal hematopoiesis associated with adverse outcomes.N. Engl. J. Med.371, 2488–2498 (2014).
Busque, L. et al. Recurrent somatic TET2 mutations in normal elderly individuals with clonal hematopoiesis.Nat. Genet.44, 1179–1181 (2012).
Anderson, K. et al. Genetic variegation of clonal architecture and propagating cells in leukaemia.Nature469, 356–361 (2011).
Li, A.H., Rosenquist, R., Forestier, E., Lindh, J. & Roos, G. Detailed clonality analysis of relapsing precursor B acute lymphoblastic leukemia: implications for minimal residual disease detection.Leuk. Res.25, 1033–1045 (2001).
de Haas, V. et al. Quantification of minimal residual disease in children with oligoclonal B-precursor acute lymphoblastic leukemia indicates that the clones that grow out during relapse already have the slowest rate of reduction during induction therapy.Leukemia15, 134–140 (2001).
Notta, F. et al. Evolution of human BCR-ABL1 lymphoblastic leukaemia-initiating cells.Nature469, 362–367 (2011).
Ding, L. et al. Clonal evolution in relapsed acute myeloid leukaemia revealed by whole-genome sequencing.Nature481, 506–510 (2012).
Jan, M. et al. Clonal evolution of preleukemic hematopoietic stem cells precedes human acute myeloid leukemia.Sci. Transl. Med.4, 149ra118 (2012).
Paguirigan, A.L. et al. Single-cell genotyping demonstrates complex clonal diversity in acute myeloid leukemia.Sci. Transl. Med.7, 281re2 (2015).
Puente, X.S. et al. Non-coding recurrent mutations in chronic lymphocytic leukaemia.Nature526, 519–524 (2015).
Landau, D.A. et al. Mutations driving CLL and their evolution in progression and relapse.Nature526, 525–530 (2015).
Makishima, H. et al. Dynamics of clonal evolution in myelodysplastic syndromes.Nat. Genet.49, 204–212 (2017).
Mossner, M. et al. Mutational hierarchies in myelodysplastic syndromes dynamically adapt and evolve upon therapy response and failure.Blood128, 1246–1259 (2016).
Miyamoto, T., Weissman, I.L. & Akashi, K. AML1/ETO-expressing nonleukemic stem cells in acute myelogenous leukemia with 8;21 chromosomal translocation.Proc. Natl. Acad. Sci. USA97, 7521–7526 (2000).
Shlush, L.I. et al. Identification of pre-leukaemic haematopoietic stem cells in acute leukaemia.Nature506, 328–333 (2014).
Damm, F. et al. Acquired initiating mutations in early hematopoietic cells of CLL patients.Cancer Discov.4, 1088–1101 (2014).
Kikushige, Y. et al. Self-renewing hematopoietic stem cell is the primary target in pathogenesis of human chronic lymphocytic leukemia.Cancer Cell20, 246–259 (2011).
Chung, S.S. et al. Hematopoietic stem cell origin of BRAFV600E mutations in hairy cell leukemia.Sci. Transl. Med.6, 238ra71 (2014).
Sperling, A.S., Gibson, C.J. & Ebert, B.L. The genetics of myelodysplastic syndrome: from clonal haematopoiesis to secondary leukaemia.Nat. Rev. Cancer17, 5–19 (2017).
Walter, M.J. et al. Clonal architecture of secondary acute myeloid leukemia.N. Engl. J. Med.366, 1090–1098 (2012).
Green, M.R. et al. Mutations in early follicular lymphoma progenitors are associated with suppressed antigen presentation.Proc. Natl. Acad. Sci. USA112, E1116–E1125 (2015).
Xie, M. et al. Age-related mutations associated with clonal hematopoietic expansion and malignancies.Nat. Med.20, 1472–1478 (2014).
Corces-Zimmerman, M.R., Hong, W.J., Weissman, I.L., Medeiros, B.C. & Majeti, R. Preleukemic mutations in human acute myeloid leukemia affect epigenetic regulators and persist in remission.Proc. Natl. Acad. Sci. USA111, 2548–2553 (2014).
Horiike, S. et al. Distinct genetic involvement of the TP53 gene in therapy-related leukemia and myelodysplasia with chromosomal losses of Nos 5 and/or 7 and its possible relationship to replication error phenotype.Leukemia13, 1235–1242 (1999).
Side, L.E. et al. RAS, FLT3, and TP53 mutations in therapy-related myeloid malignancies with abnormalities of chromosomes 5 and 7.Genes Chromosom. Cancer39, 217–223 (2004).
Wong, T.N. et al. Role of TP53 mutations in the origin and evolution of therapy-related acute myeloid leukaemia.Nature518, 552–555 (2015).
Takahashi, K. et al. Preleukaemic clonal haemopoiesis and risk of therapy-related myeloid neoplasms: a case-control study.Lancet Oncol.18, 100–111 (2017).
Gibson, C.J. et al. Clonal hematopoiesis associated with adverse outcomes after autologous stem-cell transplantation for lymphoma.J. Clin. Oncol.35, 1598–1605 (2017).
Young, N.S., Calado, R.T. & Scheinberg, P. Current concepts in the pathophysiology and treatment of aplastic anemia.Blood108, 2509–2519 (2006).
Socié, G., Rosenfeld, S., Frickhofen, N., Gluckman, E. & Tichelli, A. Late clonal diseases of treated aplastic anemia.Semin. Hematol.37, 91–101 (2000).
Yoshizato, T. et al. Somatic mutations and clonal hematopoiesis in aplastic anemia.N. Engl. J. Med.373, 35–47 (2015).
Maciejewski, J.P., Risitano, A., Sloand, E.M., Nunez, O. & Young, N.S. Distinct clinical outcomes for cytogenetic abnormalities evolving from aplastic anemia.Blood99, 3129–3135 (2002).
Dumitriu, B. et al. Telomere attrition and candidate gene mutations preceding monosomy 7 in aplastic anemia.Blood125, 706–709 (2015).
Katagiri, T. et al. Frequent loss of HLA alleles associated with copy number-neutral 6pLOH in acquired aplastic anemia.Blood118, 6601–6609 (2011).
Afable, M.G. II et al. SNP array-based karyotyping: differences and similarities between aplastic anemia and hypocellular myelodysplastic syndromes.Blood117, 6876–6884 (2011).
Hillmen, P., Lewis, S.M., Bessler, M., Luzzatto, L. & Dacie, J.V. Natural history of paroxysmal nocturnal hemoglobinuria.N. Engl. J. Med.333, 1253–1258 (1995).
Ogawa, S. Clonal hematopoiesis in acquired aplastic anemia.Blood128, 337–347 (2016).
Quentin, S. et al. Myelodysplasia and leukemia of Fanconi anemia are associated with a specific pattern of genomic abnormalities that includes cryptic RUNX1/AML1 lesions.Blood117, e161–e170 (2011).
Horwitz, M., Benson, K.F., Person, R.E., Aprikyan, A.G. & Dale, D.C. Mutations in ELA2, encoding neutrophil elastase, define a 21-day biological clock in cyclic haematopoiesis.Nat. Genet.23, 433–436 (1999).
Klein, C. et al. HAX1 deficiency causes autosomal recessive severe congenital neutropenia (Kostmann disease).Nat. Genet.39, 86–92 (2007).
Devriendt, K. et al. Constitutively activating mutation in WASP causes X-linked severe congenital neutropenia.Nat. Genet.27, 313–317 (2001).
Bonilla, M.A. et al. Effects of recombinant human granulocyte colony-stimulating factor on neutropenia in patients with congenital agranulocytosis.N. Engl. J. Med.320, 1574–1580 (1989).
Rosenberg, P.S. et al. Stable long-term risk of leukaemia in patients with severe congenital neutropenia maintained on G-CSF therapy.Br. J. Haematol.150, 196–199 (2010).
Germeshausen, M., Ballmaier, M. & Welte, K. Incidence of CSF3R mutations in severe congenital neutropenia and relevance for leukemogenesis: Results of a long-term survey.Blood109, 93–99 (2007).
Skokowa, J. et al. Cooperativity of RUNX1 and CSF3R mutations in severe congenital neutropenia: a unique pathway in myeloid leukemogenesis.Blood123, 2229–2237 (2014).
Papaemmanuil, E. et al. Clinical and biological implications of driver mutations in myelodysplastic syndromes.Blood122, 3616–3627, quiz 3699 (2013).
Ortmann, C.A. et al. Effect of mutation order on myeloproliferative neoplasms.N. Engl. J. Med.372, 601–612 (2015).
Cortés, J.R. & Palomero, T. The curious origins of angioimmunoblastic T-cell lymphoma.Curr. Opin. Hematol.23, 434–443 (2016).
Shaknovich, R., De, S. & Michor, F. Epigenetic diversity in hematopoietic neoplasms.Biochim. Biophys. Acta1846, 477–484 (2014).
Guièze, R. & Wu, C.J. Genomic and epigenomic heterogeneity in chronic lymphocytic leukemia.Blood126, 445–453 (2015).
Li, S., Mason, C.E. & Melnick, A. Genetic and epigenetic heterogeneity in acute myeloid leukemia.Curr. Opin. Genet. Dev.36, 100–106 (2016).
Kulis, M. et al. Epigenomic analysis detects widespread gene-body DNA hypomethylation in chronic lymphocytic leukemia.Nat. Genet.44, 1236–1242 (2012).
Figueroa, M.E. et al. DNA methylation signatures identify biologically distinct subtypes in acute myeloid leukemia.Cancer Cell17, 13–27 (2010).
Milani, L. et al. DNA methylation for subtype classification and prediction of treatment outcome in patients with childhood acute lymphoblastic leukemia.Blood115, 1214–1225 (2010).
Geng, H. et al. Integrative epigenomic analysis identifies biomarkers and therapeutic targets in adult B-acute lymphoblastic leukemia.Cancer Discov.2, 1004–1023 (2012).
Li, S. et al. Distinct evolution and dynamics of epigenetic and genetic heterogeneity in acute myeloid leukemia.Nat. Med.22, 792–799 (2016).
Pan, H. et al. Epigenomic evolution in diffuse large B-cell lymphomas.Nat. Commun.6, 6921 (2015).
Sandoval, J. et al. Genome-wide DNA methylation profiling predicts relapse in childhood B-cell acute lymphoblastic leukaemia.Br. J. Haematol.160, 406–409 (2013).
Landau, D.A. et al. Locally disordered methylation forms the basis of intratumor methylome variation in chronic lymphocytic leukemia.Cancer Cell26, 813–825 (2014).
Oakes, C.C. et al. DNA methylation dynamics during B cell maturation underlie a continuum of disease phenotypes in chronic lymphocytic leukemia.Nat. Genet.48, 253–264 (2016).
Heller, G. et al. Next-generation sequencing identifies major DNA methylation changes during progression of Ph+ chronic myeloid leukemia.Leukemia30, 1861–1868 (2016).
Feinberg, A.P., Koldobskiy, M.A. & Göndör, A. Epigenetic modulators, modifiers and mediators in cancer aetiology and progression.Nat. Rev. Genet.17, 284–299 (2016).
Greenblatt, S.M. & Nimer, S.D. Chromatin modifiers and the promise of epigenetic therapy in acute leukemia.Leukemia28, 1396–1406 (2014).
Roberts, K.G. & Mullighan, C.G. Genomics in acute lymphoblastic leukaemia: insights and treatment implications.Nat. Rev. Clin. Oncol.12, 344–357 (2015).
Woods, B.A. & Levine, R.L. The role of mutations in epigenetic regulators in myeloid malignancies.Immunol. Rev.263, 22–35 (2015).
Shen, H. & Laird, P.W. Interplay between the cancer genome and epigenome.Cell153, 38–55 (2013).
Oakes, C.C. et al. Evolution of DNA methylation is linked to genetic aberrations in chronic lymphocytic leukemia.Cancer Discov.4, 348–361 (2014).
Amabile, G. et al. Dissecting the role of aberrant DNA methylation in human leukaemia.Nat. Commun.6, 7091 (2015).
Shih, A.H. et al. Mutational cooperativity linked to combinatorial epigenetic gain of function in acute myeloid leukemia.Cancer Cell27, 502–515 (2015).
Zhang, X. et al. DNMT3A and TET2 compete and cooperate to repress lineage-specific transcription factors in hematopoietic stem cells.Nat. Genet.48, 1014–1023 (2016).
Pasqualucci, L. et al. Expression of the AID protein in normal and neoplastic B cells.Blood104, 3318–3325 (2004).
Gorre, M.E. & Sawyers, C.L. Molecular mechanisms of resistance to STI571 in chronic myeloid leukemia.Curr. Opin. Hematol.9, 303–307 (2002).
Roche-Lestienne, C. et al. Several types of mutations of the Abl gene can be found in chronic myeloid leukemia patients resistant to STI571, and they can pre-exist to the onset of treatment.Blood100, 1014–1018 (2002).
Branford, S., Melo, J.V. & Hughes, T.P. Selecting optimal second-line tyrosine kinase inhibitor therapy for chronic myeloid leukemia patients after imatinib failure: does the BCR-ABL mutation status really matter?Blood114, 5426–5435 (2009).
Cortes, J. et al. Dynamics of BCR-ABL kinase domain mutations in chronic myeloid leukemia after sequential treatment with multiple tyrosine kinase inhibitors.Blood110, 4005–4011 (2007).
Woyach, J.A. et al. Resistance mechanisms for the Bruton's tyrosine kinase inhibitor ibrutinib.N. Engl. J. Med.370, 2286–2294 (2014).
Liu, T.M. et al. Hypermorphic mutation of phospholipase C, γ2 acquired in ibrutinib-resistant CLL confers BTK independency upon B-cell receptor activation.Blood126, 61–68 (2015).
Burger, J.A. et al. Clonal evolution in patients with chronic lymphocytic leukaemia developing resistance to BTK inhibition.Nat. Commun.7, 11589 (2016).
Ahn, I.E. et al. Clonal evolution leading to ibrutinib resistance in chronic lymphocytic leukemia.Blood129, 1469–1479 (2017).
Smith, C.C. et al. Validation of ITD mutations in FLT3 as a therapeutic target in human acute myeloid leukaemia.Nature485, 260–263 (2012).
Goto, E. et al. Missense mutations in PML-RARA are critical for the lack of responsiveness to arsenic trioxide treatment.Blood118, 1600–1609 (2011).
Maus, M.V., Grupp, S.A., Porter, D.L. & June, C.H. Antibody-modified T cells: CARs take the front seat for hematologic malignancies.Blood123, 2625–2635 (2014).
Davila, M.L. et al. Efficacy and toxicity management of 19-28z CAR T cell therapy in B cell acute lymphoblastic leukemia.Sci. Transl. Med.6, 224ra25 (2014).
Lee, D.W. et al. T cells expressing CD19 chimeric antigen receptors for acute lymphoblastic leukaemia in children and young adults: a phase 1 dose-escalation trial.Lancet385, 517–528 (2015).
Maude, S.L. et al. Chimeric antigen receptor T cells for sustained remissions in leukemia.N. Engl. J. Med.371, 1507–1517 (2014).
Restifo, N.P., Smyth, M.J. & Snyder, A. Acquired resistance to immunotherapy and future challenges.Nat. Rev. Cancer16, 121–126 (2016).
Chung, E.Y. et al. CD19 is a major B cell receptor-independent activator of MYC-driven B-lymphomagenesis.J. Clin. Invest.122, 2257–2266 (2012).
Sotillo, E. et al. Convergence of acquired mutations and alternative splicing of CD19 enables resistance to CART-19 immunotherapy.Cancer Discov.5, 1282–1295 (2015).
Jacoby, E. et al. CD19 CAR immune pressure induces B-precursor acute lymphoblastic leukaemia lineage switch exposing inherent leukaemic plasticity.Nat. Commun.7, 12320 (2016).
Gardner, R. et al. Acquisition of a CD19-negative myeloid phenotype allows immune escape of MLL-rearranged B-ALL from CD19 CAR-T-cell therapy.Blood127, 2406–2410 (2016).
Rayes, A., McMasters, R.L. & O'Brien, M.M. Lineage switch in MLL-rearranged infant leukemia following CD19-directed therapy.Pediatr. Blood Cancer63, 1113–1115 (2016).
Armstrong, S.A. et al. MLL translocations specify a distinct gene expression profile that distinguishes a unique leukemia.Nat. Genet.30, 41–47 (2002).
Evans, A.G. et al. Evolution to plasmablastic lymphoma evades CD19-directed chimeric antigen receptor T cells.Br. J. Haematol.171, 205–209 (2015).
Mullighan, C.G. et al. Genomic analysis of the clonal origins of relapsed acute lymphoblastic leukemia.Science322, 1377–1380 (2008).
Bardini, M. et al. Clonal variegation and dynamic competition of leukemia-initiating cells in infant acute lymphoblastic leukemia with MLL rearrangement.Leukemia29, 38–50 (2015).
Oshima, K. et al. Mutational landscape, clonal evolution patterns, and role of RAS mutations in relapsed acute lymphoblastic leukemia.Proc. Natl. Acad. Sci. USA113, 11306–11311 (2016).
Mullighan, C.G. et al. CREBBP mutations in relapsed acute lymphoblastic leukaemia.Nature471, 235–239 (2011).
Ma, X. et al. Rise and fall of subclones from diagnosis to relapse in pediatric B-acute lymphoblastic leukaemia.Nat. Commun.6, 6604 (2015).
Meyer, J.A. et al. Relapse-specific mutations in NT5C2 in childhood acute lymphoblastic leukemia.Nat. Genet.45, 290–294 (2013).
Tzoneva, G. et al. Activating mutations in the NT5C2 nucleotidase gene drive chemotherapy resistance in relapsed ALL.Nat. Med.19, 368–371 (2013).
Li, B. et al. Negative feedback-defective PRPS1 mutants drive thiopurine resistance in relapsed childhood ALL.Nat. Med.21, 563–571 (2015).
Ariës, I.M. et al. Towards personalized therapy in pediatric acute lymphoblastic leukemia: RAS mutations and prednisolone resistance.Haematologica100, e132–e136 (2015).
Jones, C.L. et al. MAPK signaling cascades mediate distinct glucocorticoid resistance mechanisms in pediatric leukemia.Blood126, 2202–2212 (2015).
Estey, E., Keating, M.J., Pierce, S. & Stass, S. Change in karyotype between diagnosis and first relapse in acute myelogenous leukemia.Leukemia9, 972–976 (1995).
Raghavan, M. et al. Segmental uniparental disomy is a commonly acquired genetic event in relapsed acute myeloid leukemia.Blood112, 814–821 (2008).
Parkin, B. et al. Clonal evolution and devolution after chemotherapy in adult acute myelogenous leukemia.Blood121, 369–377 (2013).
Sood, R. et al. Somatic mutational landscape of AML with inv(16) or t(8;21) identifies patterns of clonal evolution in relapse leukemia.Leukemia30, 501–504 (2016).
Krönke, J. et al. Clonal evolution in relapsed NPM1-mutated acute myeloid leukemia.Blood122, 100–108 (2013).
Nadeu, F. et al. Clinical impact of clonal and subclonal TP53, SF3B1, BIRC3, NOTCH1, and ATM mutations in chronic lymphocytic leukemia.Blood127, 2122–2130 (2016).
Pui, C.H. et al. Clinical utility of sequential minimal residual disease measurements in the context of risk-based therapy in childhood acute lymphoblastic leukaemia: a prospective study.Lancet Oncol.16, 465–474 (2015).
Kim, J.Y. & Gatenby, R.A. Quantitative clinical imaging methods for monitoring intratumoral evolution.Methods Mol. Biol.1513, 61–81 (2017).
Batlevi, C.L., Matsuki, E., Brentjens, R.J. & Younes, A. Novel immunotherapies in lymphoid malignancies.Nat. Rev. Clin. Oncol.13, 25–40 (2016).
Notta, F. et al. Distinct routes of lineage development reshape the human blood hierarchy across ontogeny.Science351, aab2116 (2016).
Sun, J. et al. Clonal dynamics of native haematopoiesis.Nature514, 322–327 (2014).
Busque, L. et al. Nonrandom X-inactivation patterns in normal females: lyonization ratios vary with age.Blood88, 59–65 (1996).
Kwok, B. et al. MDS-associated somatic mutations and clonal hematopoiesis are common in idiopathic cytopenias of undetermined significance.Blood126, 2355–2361 (2015).
Young, A.L., Challen, G.A., Birmann, B.M. & Druley, T.E. Clonal haematopoiesis harbouring AML-associated mutations is ubiquitous in healthy adults.Nat. Commun.7, 12484 (2016).
Jones, P.A. Functions of DNA methylation: islands, start sites, gene bodies and beyond.Nat. Rev. Genet.13, 484–492 (2012).
Acknowledgements
We thank M. Mittelbrunn (CBM-Hospital 12 de Octubre, Madrid, Spain), X.S. Puente (Universidad de Oviedo, Oviedo, Spain), P. Menéndez (J. Carreras Leukemia Research Institute, Barcelona, Spain), R. Rabadán (Columbia University, New York, New York, USA), J. Soulier (Université Paris Diderot, Paris, France) and all members of our labs for their helpful comments on the manuscript. A.A.F. is supported by grants from the National Cancer Institute (NCI) of the National Institutes of Health (NIH), the Leukemia & Lymphoma Society, the Chemotherapy Foundation and the Rally Foundation. C.L.-O. is supported by grants from European Union (DeAge, ERC-Advanced Grant), Ministerio de Economía y Competitividad SAF2014-52413-R, Instituto de Salud Carlos III (RTICC), CIBERONC, Plan Feder, and EDP Foundation. The generous support by J.I. Cabrera is also acknowledged.
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Department of Pediatrics, Columbia University, New York, New York, USA
Adolfo A Ferrando
Department of Pathology and Cell Biology, Columbia University, New York, New York, USA
Adolfo A Ferrando
Institute for Cancer Genetics, Columbia University, New York, New York, USA
Adolfo A Ferrando
Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Instituto Universitario de Oncología (IUOPA), Universidad de Oviedo, Oviedo, Spain
Carlos López-Otín
Centro de Investigación Biomédica en Red de Cáncer, Spain
Carlos López-Otín
- Adolfo A Ferrando
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- Carlos López-Otín
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Correspondence toAdolfo A Ferrando orCarlos López-Otín.
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Ferrando, A., López-Otín, C. Clonal evolution in leukemia.Nat Med23, 1135–1145 (2017). https://doi.org/10.1038/nm.4410
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