Figure 3. Clonal hematopoiesis in acquired aplastic anemia.

Immune mediated selection pressure drives expansion of HSPCs with context-specific growth advantage. Some clones may expand during the initial phase of disease due to a capacity for immune evasion, but may recede after successful immunosuppressive therapy (IST) and hematologic recovery (green circles). Other clones with typical myeloid driver mutations may display more context-independent expansion (red circles).