Adhikari, S.; Eldfors, S.; Pitkanen, E.; Vaha-Koskela, M.; Heckman, C.

Background Acute myeloid leukemia (AML) progresses by the accumulation of somatic mutations and clonal expansion of pre-leukemic cells. Patients may respond to initial therapy, but often relapse, underscoring an evolving disease. Next generation sequencing technologies are being applied to AML for risk stratification and monitoring treatment response. We aimed to evaluate the efficiency of whole exome sequencing (WES) and single-cell DNA sequencing (scDNA-seq) for determining clonal heterogeneity and evolution in AML induced by treatment, assessing strengths and limitations of each technology. Methods We conducted WES and scDNA-seq on samples from 6 patients with AML, including sequential samples from four patients. We identified somatic variants, clonal composition and phylogeny using both technologies and compared the results. Results WES detected more variants and clones due to broader coverage, while scDNA-seq provided clonality results for targeted genes revealing zygosity and rare clones. Both techniques missed clinically important variants, posing challenges for clinical application. However, they identified similar founding clones and strong correlation of variant allele frequencies and clonal prevalences. Conclusions As both technologies can overlook variants, multiple technologies should be utilized to understand clonality in heterogeneous diseases such as AML. Careful scDNA-seq target panel planning, utilizing knowledge obtained from bulk sequencing, can offer more information on clonal heterogeneity.