Fish plots showing the clonal evolution from primary tumor to first and second relapse for all double-relapse patients. Model of clonal progression during the course of disease for patient AML47 (A) and patient AML57 (B). For founding clone (gray), primary specific clone (yellow), and relapse-enriched clone (blue), exemplary clone-defining genes are shown. The remaining genes and their affiliation to 1 of the clones, as well as a more detailed evolutionary tree, can be found in supplemental Figures 16 and 17. For diagnosis, Rel1, and Rel2, the proportion of each subclone is shown as the percentage of the whole cell content. AML05 (C) and AML07 (D) from the group with an analogous mutation profile at diagnosis and relapse (group A) were depicted in the same manner. The RUNX1–RNX1T1 fusion was detected in all time points.