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Figure 2 | Journal of Hematology & Oncology

Figure 2

From: Cancer stem cells in basic science and in translational oncology: can we translate into clinical application?

Figure 2

Subclone formation of CSC during evolution of a malignancy. During cancer/leukemia evolution, a large number of different subclones with varying combinations of mutational lesions develop. Each change in color is indicative of the acquisition of a relevant new molecular lesion. After a certain time, one or more malignant (dominant) subclones expand and develop into an overt malignancy. However, at the time of diagnosis of a cancer/leukemia, all the other premalignant subclones and their stem cells are also still present. Neoplastic stem cells are indicated by bold circles. After intensive therapy, many or most (sometimes all) of the cancer/leukemic stem cells may have been eradicated. However, the less malignant (pre-malignant) neoplastic stem cells may still survive (because of their quiescence and other resistance-related mechanisms) and may later expand and produce a relapse. Such late relapses may not necessarily express the same oncogenic lesions (driver mutations) compared to the original subclone but still are derived from the same initial stem cell clone. Today, the subclonal architecture is demonstrable by deep sequencing technologies in various malignancies.

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