Clonal Adaptation in Bone Marrow Failure: a Mechanism of Protection from Leukemia Development
Lecture date: November 19, 2026
Marcin Wlodarski, MD, PhD
Member, Director of Bone Marrow Failure and MDS Program
St. Jude Children's Research Hospital
Clonal hematopoiesis in bone marrow failure is frequently adaptive rather than malignant: hematopoietic stem cells acquire somatic alterations that relieve a preexisting germline or immune-mediated growth restriction. These benign rescue clones can reconstitute hematopoiesis and sustain durable remission. They may divert stem cells away from the maladaptive routes (such as monosomy 7) that drive leukemia development. Recognizing that not all acquired clones in marrow failure have malignant potential is essential for correct prognostication and avoiding unnecessary interventions.
