{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:27:45Z","timestamp":1787300865818,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>This retrospective, single\u2010center study aimed to characterize clonal dynamics of GPI\u2010deficient cells in patients with paroxysmal nocturnal hemoglobinuria (PNH) or PNH\/aplastic anemia (AA) syndrome using multiparameter flow cytometry including FLAER. Among 108 patients diagnosed and treated at our center, 83 had longitudinal monitoring of GPI\u2010deficient neutrophils; 53 of these also had data on monocytes and lymphocytes. Median observation time was 29.4\u2009months (range 1.1\u2013162.7\u2009months). Clone size in neutrophils showed a strong correlation with monocytes, but not with lymphocytes. Clonal persistence represented the most frequent individual pattern of clone evolution observed during follow\u2010up; clonal persistence was observed in 32\/83 patients, while 24 patients exhibited clonal expansion (\u2265\u200910%) and 13 showed regression. Expansion frequently involved all three lineages, suggesting ongoing biological mechanisms contributing to clonal selection. Regression was more likely in patients with small initial clones. In six patients undergoing allogeneic stem cell transplantation, complete eradication of PNH clones was achieved. Clonal dynamics were independent of eculizumab treatment; however, regression was observed in some patients treated with ATG and cyclosporine A. These findings support the need for longitudinal clone size monitoring, particularly in neutrophils and monocytes. Further studies are warranted to elucidate factors influencing clone expansion and remission.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    25\u201012\u2009634\u2010BO\n                  <\/jats:p>","DOI":"10.1111\/ejh.70293","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:18:13Z","timestamp":1787300293000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clonal Dynamics of\n                    <scp>GPI<\/scp>\n                    \u2010Deficient Cells in Patients With Paroxysmal Nocturnal Hemoglobinuria (\n                    <scp>PNH<\/scp>\n                    ): A Retrospective Follow\u2010Up Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8725-6484","authenticated-orcid":false,"given":"Sandra M.","family":"Frey","sequence":"first","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center University Hospital Essen, University of Duisburg\u2010Essen  Essen Germany"},{"name":"Department of Hematology and Central Hematology Laboratory, Inselspital University Hospital Bern, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike","family":"Poppenborg","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center University Hospital Essen, University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Schm\u00fccker","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center University Hospital Essen, University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Preising","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center University Hospital Essen, University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5706-9349","authenticated-orcid":false,"given":"H. Christian","family":"Reinhardt","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center University Hospital Essen, University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4414-7699","authenticated-orcid":false,"given":"Alexander","family":"R\u00f6th","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center University Hospital Essen, University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7530-8892","authenticated-orcid":false,"given":"Ferras","family":"Alashkar","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center University Hospital Essen, University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"issue":"2","key":"e_1_2_12_2_1","first-page":"205","article-title":"Paroxysmal Nocturnal Hemoglobinuria: Pathophysiology, Natural History and Treatment Options in the Era of Biological Agents","volume":"2","author":"Risitano A. M.","year":"2008","journal-title":"Biologics"},{"issue":"2","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/BF02983210","article-title":"Pathogenesis of Selective Expansion of PNH Clones","volume":"77","author":"Nakakuma H.","year":"2003","journal-title":"International Journal of Hematology"},{"issue":"5","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1309\/AT9Y6WR03PX1K228","article-title":"Differential Usefulness of Various Markers in the Flow Cytometric Detection of Paroxysmal Nocturnal Hemoglobinuria in Blood and Bone Marrow","volume":"126","author":"Olteanu H.","year":"2006","journal-title":"American Journal of Clinical Pathology"},{"issue":"8","key":"e_1_2_12_5_1","first-page":"1326","article-title":"Blood Cell Flow Cytometry in Paroxysmal Nocturnal Hemoglobinuria: A Tool for Measuring the Extent of the PNH Clone","volume":"10","author":"Alfinito F.","year":"1996","journal-title":"Leukemia"},{"issue":"6","key":"e_1_2_12_6_1","first-page":"315","article-title":"Recommendations for Flow Cytometric Diagnosis and Monitoring of PNH","volume":"35","author":"Schrezenmeier H.","year":"2012","journal-title":"Journal of Laboratory Medicine"},{"key":"e_1_2_12_7_1","first-page":"257","article-title":"Flow Cytometric Analysis of GPI\u2010Deficient Cells for the Diagnosis of Paroxysmal Nocturnal Hemoglobinuria (PNH)","volume":"27","author":"Nebe T.","year":"2003","journal-title":"Journal of Laboratory Medicine"},{"issue":"4","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1002\/cyto.b.20525","article-title":"Guidelines for the Diagnosis and Monitoring of Paroxysmal Nocturnal Hemoglobinuria and Related Disorders by Flow Cytometry","volume":"78","author":"Borowitz M. 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