Extended Data Fig. 5: DNA hypermutation signature in CSF.

Disease course for patient 36 with GBM with two tumour resections and one CSF collection. The patient received 14 monthly cycles of temozolomide (TMZ) following the initial tumour resection and postoperative radiation (RT)/TMZ. The initial tumour harboured five mutations, the recurrent tumour 120 mutations and the CSF 132 mutations. MRIs (T1 post-contrast) are shown from the time of diagnosis, first recurrence and second recurrence. The original tumour was in the right parietal lobe and recurrence was in the right frontal lobe. Diamond, tumour samples profiled; circle, CSF sample profiled. Bev, bevacizumab. The bar graph shows the precise number of SNVs that were called by the IMPACT pipeline in the recurrent tumour (n = 120 independent somatic SNVs) and in CSF ctDNA (n = 132 independent somatic SNVs; INDELs were excluded). Bar graphs show the precise number of SNVs for each of the possible trinucleotide combinations.