Fish plot illustrating mutation profile and clonal dynamics of patient 1. This patient progressed to lymphoid blast crisis within 3 months of diagnosis. This figure illustrates the complex clonal dynamics involved, with the fish plot highlighting the primary BCR::ABL1 clone in addition to the 3 subclones, including expansion of the IKZF1 subclone detectable at diagnosis in addition to the acquisition of T315I as well as loss of TP53. Detection of all variants involved NGS, Sanger sequencing, and cytogenetic analysis. The IKZF1 deletion is indicated by aberrant splicing, with the breakpoints indicated by the red arrows. The T315I mutation is shown on NGS while the loss of TP53 is indicated via fluorescence in situ hybridization probes. Combination chemotherapy in addition to ponatinib enabled clearance of the leukemic clone; LBP, lymphoid blast phase.