Fig. 4: Clonal evolution of pediatric tMN.
From: The acquisition of molecular drivers in pediatric therapy-related myeloid neoplasms
a A river plot showing a representative case where tMN variants occurred only after exposure to cytotoxic therapy. In this case the founding tMN clone was detectable 628 days prior to morphologic diagnosis of tMDS. b A 2-dimensional VAF plot showing that the tMN and de novo AML were actually related via a NUP98-NDS1 fusion (red triangle) and a subclonal WT1 variant. c, d River- and 2d-plots showing an ALL related to the subsequent tMN through an ASXL1-mutant founding clone with a SMARCA2 subclone, and following chemotherapy an outgrowth of the SMARCA2 clone with subsequent acquisition of 2 TP53 subclones. e, f River- and 2d-plots showing staging bone marrow collected at time of NHL diagnosis related to the subsequent tMN through a RUNX1 founding clone with eventual acquisition BCORL1 and KRAS subclones, which paralleled the development of tMDS and tAML, respectively. 2-d plot NOTE: upper right-hand quadrant contains shared variants between the 2 time-points (X and Y axes). Open symbols indicate variants with WGS or WES only. Closed symbols indicate variants validated via capture resequencing.
