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Despite favorable prognostic indicators, including the absence of cytogenetic abnormalities and minimal residual disease (MRD) negativity, relapse remains a major clinical concern.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      We investigated the clinical significance of immunoglobulin heavy chain (IGH) clonality using RNA sequencing data in BCP\u2010ALL. We analyzed IGH clonality from 136 patients. IGH abundance followed a power law distribution, which enabled us to identify disease clones as outliers based on read count. In total, 330 disease clones were detected, and patients were categorized into three clonotype groups: undetectable disease clone (UDC), incomplete disease clone (IDC), and complete disease clone (CDC). Clinical outcomes were compared across clonotypes, including in subgroups with high hyperdiploidy (HHD) and MRD negativity. Among patients with HHD, significant prognostic differences were observed across clonotypes (event\u2010free survival [EFS],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01; overall survival [OS],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.08), even among those who were MRD\u2010negative (EFS,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01; OS,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). Furthermore, comparisons of IGH sequences between diagnosis and relapse indicated that while initial disease clones often contributed to relapse, newly expanded clones frequently emerged, particularly in patients with HHD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight the importance of analyzing the IGH repertoire in refining risk stratification and underscore the need for advanced sequencing\u2010based MRD monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71336","type":"journal-article","created":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T15:00:06Z","timestamp":1762095606000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Impact of Immunoglobulin Heavy Chain Clonality in Pediatric B\u2010Cell Precursor Acute Lymphoblastic Leukemia"],"prefix":"10.1002","volume":"14","author":[{"given":"Yuta","family":"Katai","sequence":"first","affiliation":[{"name":"Department of Pediatrics Kitano Hospital, Tazuke Kofukai Medical Research Institute  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0472-4663","authenticated-orcid":false,"given":"Tatsuya","family":"Kamitori","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology Saitama Children's Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8930-3539","authenticated-orcid":false,"given":"Satoshi","family":"Saida","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Graduate School of Medicine Kyoto University  Kyoto 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