growth advantage of remission clone after AML Tx

We reported a case of AML which we tracked mutation dynamics over 9 years. Unexpectedly, we observed a subgroup of mutations expanded during complete remission (termed a remission clone). To investigate the nature of the remission clone, we performed the flow cytometry-based cell sorting followed by amplicon sequencing. The remission clone expanded after repeated chemotherapies in the myeloid lineage (stem cell, progenitor cell, myeloid cell) and then suppressed when the leukemic clone re-populated during relapse. In lymphoid lineages (B-cell, T-cell), remission clone was observed at all times. Among mutations in the remission clone, NR2C2 A93V mutant showed growth advantage compared to the wildtype NR2C2, mutants of other mutations in the remission clone, and wildtype cells (p < 0.05). The remission clone suggests the growth advantage after chemotherapy, is distinct from the leukemic clone. The remission clone is observed in both myeloid and lymphoid lineages and it can be assumed that this mutation occurs in the early hematopoietic stem cell lineage.