TERRA is constitutively expressed in low levels in patients with TBD, patients with ALL, and healthy donors. Patients with AML present a distinct pattern. (A) Violin plots of telomere length in the initial cohort. The patients with AML and TBD demonstrated the shortest telomere repeat copy number/single gene copy number (T/S) ratios compared with the BM and PB controls. (B) Violin plot of TERRA expression in the initial cohort. Patients with ALL and TBD demonstrate a similar level of TERRA expression compared with the BM and PB controls. (C) Spearman correlation matrix of TERRA 10q, 15q, 20q, XqYq, and telomere length among all cases included. TERRA expression is not upregulated by telomere shortening (P > .05). (D) Violin plot of R-loops in 8 samples. AML and ALL demonstrated high R-loops compared with the BM and PB controls.