Bone marrow aspirate and molecular analysis. (A) Bone marrow aspiration cytology (hematoxylin and eosin staining; original magnification ×1000). a) April 2014, showing vacuoles in myelomonocytic precursor cells and erythroblast. (b) June 2019, showing no vacuolation in myelomoncytic precursor cells at CML diagnosis. (c) January 2020 and (d) March 2022: showing vacuoles in myelomonocytic precursor cells and erythroblasts. (B) Visualization of clonal dynamics (performed using R v. 4.3.1 and package fishplot version 0.23) between UBA1 variant p.Met41Val allele burden (variant allele frequency %) and BCR-ABL:ABL1 ratios (International Scale (IS) %). Line, CML diagnosis in June 2019; ▼ imatinib initiation in July 2019; ∗ imatinib withdrawal in November 2019; ♦ nilotinib initiation in February 2020.
