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01-02-2017 | Image

Figure 1. Hypothetical example of clonal evolution and heterogeneity in patients with multiple myeloma (MM) over the disease course.

MM is characterized by clonal heterogeneity. As the disease progresses and patients receive various therapies, different clones may emerge and become dominant, thus contributing to treatment resistance typical of patients with relapsed/refractory MM. (a) The clonal distribution at diagnosis, prior to treatment with lenalidomide plus dexamethasone. (b) An emergence of clone 2 at relapse, prior to re-treatment with lenalidomide plus dexamethasone. (c) Emergence of a lenalidomide-resistant clone 3. BMSC=bone marrow stromal cells.

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