PMC7191213_01
Myeloid clonal evolution during treatment. Variant allele frequency (VAF) of mutations evaluated using NGS and Serum Free Light Chain (SFLC) measurement during treatment with induction chemotherapy (7+3), AZA/Len, and AZA/daratumumab.
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AZA/Len, free light chain and bone marrow aspirate confirmed ongoing AML response and very good partial response (VGPR) for MM. After 12 cycles, bone marrow biopsy showed no blast excess and 10% plasma cells. AZA/Len was continued, and the lenalidomide dose was reduced to 15 mg/d, 21 d/4 w due to cytopenia until September 2017, when SLFC measurement showed MM relapse (Figure 1). CR and MM VGPR (Figure 1). Clonal repartition remained remarkably stable after this time, except for the expansion of a PHF6-containing clone and additional mutations of ASXL1, PHF6 and TET2 in June 2016, with no evidence of disease progression for AML or MM.