随后遗传病变的获得（克隆进化，CE）和/或现有克隆的扩展（CEXP）有助于骨髓增生异常综合征（MDS）中的克隆动力学（CD）。尽管 CD 在高危患者的疾病进展和转化为急性髓系白血病 (AML) 中发挥着重要作用，但由于缺乏可靠的纵向数据，考虑到长期的研究，对低危 MDS (LR-MDS) 患者的 CD 的了解有限。临床上病情稳定。在这项回顾性分析中，我们在未经选择的现实世界 LR-MDS 患者队列中描述了 CD 的频率和预后影响。我们筛选了 68 名患者，中位随访时间为 40.5 个月，中位时间点为 7.5 个（范围：2-22）个时间点，通过染色体显带分析、荧光原位杂交、测序和分子核型分析检测 CE 和 CEXP。在 30/68 名患者中，记录了 47 次 CE 事件和每 4 年 1 次 CD 事件。值得注意的是，至少发生 1 次 CE 事件的患者接受后续治疗的可能性增加。出乎意料的是，CE 与较差的结果无关，这可以通过 CD 检测触发随后开始疾病缓解治疗来合理解释。© 2024 作者。约翰·威利 (John Wiley) 出版的 HemaSphere

The acquisition of subsequent genetic lesions (clonal evolution, CE) and/or the expansion of existing clones (CEXP) contributes to clonal dynamics (CD) in myelodysplastic syndromes (MDS). Although CD plays an important role in high-risk patients in disease progression and transformation into acute myeloid leukemia (AML), knowledge about CD in lower-risk MDS (LR-MDS) patients is limited due to lack of robust longitudinal data considering the long clinically stable courses of the disease. In this retrospective analysis, we delineate the frequency and the prognostic impact of CD in an unselected real-world cohort of LR-MDS patients. We screened 68 patients with a median follow-up of 40.5 months and a median of 7.5 (range: 2-22) timepoints for CE and CEXP detected by chromosomal banding analysis, fluorescence in situ hybridization, sequencing, and molecular karyotyping. In 30/68 patients, 47 CE events and a CD rate of 1 event per 4 years were documented. Of note, patients with at least 1 CE event had an increased probability for subsequent treatment. Unexpectedly, CE did not correlate with inferior outcomes, which could be reasonably explained by CD detection triggering the subsequent start of a disease-modifying therapy.© 2024 The Author(s). HemaSphere published by John Wiley & Sons Ltd on behalf of European Hematology Association.