Figure 1.

Clonal hematopoiesis in myelodysplastic syndromes (MDS) and transformation to secondary acute myeloid leukemia (sAML). Mutations in hematopoietic stem cell (HSC) clones occur at any time of our life as part of the aging process. While most mutations are background mutations that do not affect cellular properties, some mutations provide an advantage to HSCs, such as increased self-renewal. These mutations drive clonal expansion and the eventual development of the asymptomatic clonal hematopoiesis of indeterminate potential (CHIP). The further expansion frequently driven by the acquisition of additional genetic alterations can lead to MDS. The gain of additional driver mutations can further lead to transformation to sAML. This figure has been inspired by [7].