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In this retrospective multicenter study, we evaluated mutational dynamics of AML cells in 57 patients with relapse after allo-HCT. We observed that 68% of patients exhibited genetic instability, characterized by acquisition or loss of mutations, most frequently involving\n                    <jats:italic>FLT3-ITD, NRAS<\/jats:italic>\n                    , and\n                    <jats:italic>KRAS<\/jats:italic>\n                    , while founding lesions such as\n                    <jats:italic>DNMT3A<\/jats:italic>\n                    were usually retained. Clonal evolution patterns varied, with constant profiles (35.0%), linear (29.8%), branching (22.8%), and parallel (12.3%) evolution. However, these evolutionary categories were not associated with differences in progression-free or overall survival. In contrast, relapse timing was highly prognostic: early relapse (\u2009\u2264\u20096 months) conferred a significant higher mortality risk compared to late relapse, independent of evolution model. Our findings indicate that while relapse after allo-HCT in AML is genetically diverse, timing of recurrence remains the most critical determinant of outcome. Given that certain genetic changes may inform therapeutic options, these findings highlight the relevance of longitudinal molecular monitoring especially during the early post-transplant period.\n                  <\/jats:p>","DOI":"10.1038\/s41409-026-02813-4","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T12:13:08Z","timestamp":1775218388000},"page":"677-684","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Mutational landscape changes of AML in patients relapsing after allogeneic hematopoietic cell transplantation"],"prefix":"10.1038","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1788-2807","authenticated-orcid":false,"given":"Kristina","family":"Maas-Bauer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1868-2083","authenticated-orcid":false,"given":"Thomas","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehtap","family":"Y\u00fccel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Garofalaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Ko\u00dfmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Biavasco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Memnon","family":"Lysandrou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7382-4551","authenticated-orcid":false,"given":"Miguel","family":"Waterhouse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Feuchtinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Pfeifer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Ingelfinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Wertheimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7325-7753","authenticated-orcid":false,"given":"Justus","family":"Duyster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3078-5024","authenticated-orcid":false,"given":"Jae Sook","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5810-1192","authenticated-orcid":false,"given":"Robert J.","family":"Soiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1799-5927","authenticated-orcid":false,"given":"J\u00fcrgen","family":"Finke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0813-3444","authenticated-orcid":false,"given":"Ralph","family":"W\u00e4sch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3097-2532","authenticated-orcid":false,"given":"Alexandros","family":"Spyridonidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9228-1793","authenticated-orcid":false,"given":"Dennis Dong Hwan","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5037-6175","authenticated-orcid":false,"given":"Claudia","family":"Wehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6565-3393","authenticated-orcid":false,"given":"Robert","family":"Zeiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"2813_CR1","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1182\/blood.2022015850","volume":"140","author":"DA Arber","year":"2022","unstructured":"Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, et al. 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RZ received honoraria from Incyte, Novartis, Sanofi and Mallinckrodt all outside of the work reported here. RW consulted for and\/or received honoraria from Abbvie, Alexion, Amgen, BMS, Johnson & Johnson, Kite\/Gilead, Novartis, Pfizer, Sanofi, Takeda and received research funding from Johnson & Johnson and Sanofi all paid to UKF. CW received travel support or honoraria from Takeda, Jazz Pharmaceuticals, mundipharma and Grifols. RJS consulted and\/or received honoraria from BMS, Cugene and Merck.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}