Figure 2.

Possible outcomes in AML. Fish diagrams showing clonal evolution in the four possible AML outcomes. Refractoriness and early relapse are diagnosed using cytomorphology and are characterized by the early persistence of most, if not all, lesions, found at the diagnosis. Later relapse occurs after a period of complete remission, where no excess blast is seen, but where most lesions persist at low levels. A peculiar condition is represented by the persistence of clonal hematopoiesis in patients who are in long-lasting remission but retain a founder clone with the most frequent DNMT3A mutations. Finally, patients are cured when all mutant cells are cleared from the bone marrow. In these last three outcomes, cytometric and molecular measurable residual diseases (MRD) evaluations are critical for patient monitoring. #1, #2, #3 etc. indicate the successive genetic lesions.