Figure 6 Proposed model of clonal evolution in multiple myeloma

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Figure 6 Proposed model of clonal evolution in multiple myeloma Figure 6 | Proposed model of clonal evolution in multiple myeloma. This model represents the most frequently co-occurring mutations that drive clonal evolution from monoclonal gammaopathy of undetermined significance (MGUS) to multiple myeloma (MM). Clones are represented as circles. The primary genomic events affecting certain clones (represented in grey) include hyperdiploid tumours (HRD), translocations in the genes encoding the immunoglobulin heavy chains (IGH), and 13q deletion. Secondary events (coloured clones) are represented on the background of the main primary events with which they are associated6,9. Translocations involving MYC can still be detected in some individuals harbouring translocations affecting IGH, but have not been depicted for clarity. Moreover, del(17p) can arise in any multiple myeloma clones, and has been represented at the intersection of HRD tumours and non-HRD tumours. del, deletion; SMM, smouldering multiple myeloma; t, translocation. Manier, S. et al. (2016) Genomic complexity of multiple myeloma and its clinical implications Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2016.122