Leukemia early evolution

Leukemia is bone marrow failure due to the outgrowth of clonal cells. Patients will present to the clinic with bone marrow failure, however the disease starts many years before that. A preleukemic phase that precedes bone marrow failure can be identified in most cases of leukemia. In the preleukemic phase stem/progenitor cells acquire recurrent mutations which lead to clonal hematopoiesis. Many individuals will develop clonal hematopoiesis but not all will develop leukemia in their life time. Understanding the rules of human leukemia evolution by in depth analysis of single cell phylogenetics is one of the ways we try to understand leukemia evolution.