Table III. Serial FISH results in six patients with clonal evolution.

Patients 11 and 16 evolved from a negative first fluorescence in situ hybridization (FISH) to acquisition of a “double hit” (DH). Patient 7 had two clonal evolution events, progressing from an isolated 11q- to a “double hit” and then retention of the “double hit” with acquisition of 13q- and loss of chromosome 12 centromere. Patient 17 evolved from isolated +12 to negative FISH and then acquired a “double hit” which was not observed, in the 6^th FISH study, after the patient had undergone an allogeneic bone marrow transplant. Patient 18 had a homozygous 13q deletion at first FISH and evolved to a “double hit” with homozygous 13q deletion. Patient 20 had both 13q and 17p deletions, later acquired a 6q deletion and finally acquired an 11q deletion for the “double hit”.

Patient	1st FISH Days since Dx	2nd FISH Days since Dx	3rd FISH Days since Dx	4th FISH Days since Dx	5th FISH Days since Dx	6th FISH Days since Dx	Clonal Evolution Summary
7						11q- (81%)	11q- > DH > DH + 13q- + −12cen
						13q- (11%)
				11q- (83%)	11q- (94%)	17p- (80%)
	11q- (45%)	11q- (57%)	11q- (11%)	17p- (74%)	17p- (97%)	−12cen (10%)
	975	1099	1263	1781	1920	2215
11					11q- (70%)	11q- (66%)	neg > DH
	negative	negative	negative	negative	17p- (51%)	17p- (66%)
	1394	2021	2703	2821	3218	3490
16		11q- (70%)	11q- (65%)		11q- (58%)		neg > DH
	negative	17p- (61%)	17p- (56%)	11q- (8%)	17p- (54%)
	26	1500	1647	1897	1989
17				11q- (49%)			+12 > neg > DH
	+12 (14%)	negative	negative	17p- (49%)	negative
	48	157	214	903	1126
18				11q- (15%)			13q- > DH + 13q-
				13q-x2 (96%)	13q-x2 (28%)
	13q-x2 (80%)	13q-x2 (4%)	13q-x2 (24%)	17p- (32%)	17p- (29%)
	148	349	645	2233	2460
20						6q- (27%)	13q- + 17p- > 6q- +13q- + 17p- > DH + 6q- +13q-
					6q- (26%)	11q- (47%)
	13q- (86%)	13q- (72%)		13q- (79%)	13q- (88%)	13q- (48%)
	17p- (87%)	17p- (84%)	13q- (8%)	17p- (81%)	17p- (85%)	17p- (92%)
	29	103	195	528	720	2490