Fig. 3.

Different pathways leading to relapse of AML. Gray dots, age-related, pathogenetically irrelevant passenger mutations; orange dots, early (pre-) leukemic driver mutations; red dots, late leukemic driver mutations; bright yellow dots, non-synonymous mutations newly acquired at relapse. All HSCs are assumed to accumulate mostly innocuous mutations during aging; only mutations that would be found as passenger mutations in AML are depicted in the figure. The figure does not intend to illustrate the duration of CR, or the presence or absence of minimal residual disease detectable by routine methods. Dx diagnosis, CR complete remission, LSC leukemic stem cell, HSC hematopoietic stem cell