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Nat Med. 2017 Oct 6;23(10):1135-1145. doi: 10.1038/nm.4410. [Epub ahead of print]

Clonal evolution in leukemia.

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Department of Pediatrics, Columbia University, New York, New York, USA.
Department of Pathology and Cell Biology, Columbia University, New York, New York, USA.
Institute for Cancer Genetics, Columbia University, New York, New York, USA.
Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Instituto Universitario de Oncología (IUOPA), Universidad de Oviedo, Oviedo, Spain.
Centro de Investigación Biomédica en Red de Cáncer, Spain.


Human leukemias are liquid malignancies characterized by diffuse infiltration of the bone marrow by transformed hematopoietic progenitors. The accessibility of tumor cells obtained from peripheral blood or through bone marrow aspirates, together with recent advances in cancer genomics and single-cell molecular analysis, have facilitated the study of clonal populations and their genetic and epigenetic evolution over time with unprecedented detail. The results of these analyses challenge the classic view of leukemia as a clonal homogeneous diffuse tumor and introduce a more complex and dynamic scenario. In this review, we present current concepts on the role of clonal evolution in lymphoid and myeloid leukemia as a driver of tumor initiation, disease progression and relapse. We also discuss the implications of these concepts in our understanding of the evolutionary mechanisms involved in leukemia transformation and therapy resistance.


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