Remission clone in acute myeloid leukemia shows growth advantage after chemotherapy but is distinct from leukemic clone

•A population with the same set of mutations was found in sequential remissions in the bone marrow of a patient with AML.•This “remission clone” contained mutations in NDC80, RBM5, GAS2L3, NR2C2, and SF3B2.•At relapse, the contribution of the remission clone to the myeloid lineage was markedly reduced.•NR2C2-A93V transfected into HEK-293 cells caused a significant increase in viability. In a previously published case study of acute myeloid leukemia, we tracked the dynamics of somatic mutations over 9 years. Interestingly, we observed a group of mutations that expanded during remission, which we named the “remission clone.” To determine the nature of the remission clones, we performed flow cytometry-based cell sorting followed by ultradeep sequencing. The remission clone repeatedly expanded after chemotherapeutic cycles and was suppressed during relapse in the myeloid lineage (multipotent hematopoietic stem, progenitor, and myeloid cells). On the other hand, the remission clone was consistently observed in lymphoid lineages (B and T cells) regardless of the disease state. When transfected into the HEK-293 cell line, the NR2C2(A93V) mutant exhibited a growth advantage (all p values < 0.05). The results indicate that the remission clone seems to be another form of clonal hematopoiesis, but without a clear association with leukemia. As the remission clone is present in both myeloid and lymphoid lineages, it likely originates from ancestral hematopoietic cell lineages. More importantly, the remission clone is distinct from the leukemic clone; therefore, mutations expanded during remission require special interpretation when performing next-generation sequencing-based measurable residual disease assessment.