Relapse and clonal evolution in the EPAG-IST and historic IST groups. (A) Competing risk curves (death and BMT used as competing risks) depicting the time to relapse in subjects with a response at 6 months; blue line represents patients who received CSA maintenance (n = 109) and red line shows patients who did not receive CSA maintenance (n = 36). The purple dashed line indicates 6-month landmark timepoint when CSA was discontinued in the first 44 subjects and lowered in the rest and EPAG discontinued in all. The green dashed line indicates 2-year landmark timepoint when maintenance dose CSA was discontinued. Relapses were observed to occur shortly after these 2 distinct time points. (B) In the EPAG-IST group, 134 subjects were treated with 6 months of therapeutic CSA followed by 18 months of low-dose maintenance. Of these, 109 achieved a response at 6 months, and these were compared with a historic IST group who received a similar IST regimen with 24 months of CSA total. These competing risk curves (death and BMT used as competing risks) show no difference in the rates of relapse between subjects treated with IST plus EPAG versus historic IST alone (p = 0.09). (C) The cumulative incidence of clonal evolution was noted in 14.8% of all treated patients in EPAG-IST group. (D) No difference in high-risk evolution was observed in EPAG-IST and historic IST group as shown with completing risk analysis using Fine-Gray (death and BMT used as competing risks).