Clonal evolution
No patient evolved to myelodysplastic syndrome or myeloid leukemia in
the eltrombopag group. Chromosome karyotypes were monitored regularly
during the follow-up, with no positive results. Myeloid gene mutations
were monitored regularly. Totally 11 (16.7%) patients showed somatic
myeloid gene mutations during the study, including 5 (7.6%) patients
showed positive myeloid gene mutation results before treatment; then,
three patients (4.5%) remained positive until the endpoint, and the
other two patients (3.0%) became negative. Totally 6 patients (9.1%)
because positive after IST. In the eltrombopag group, PNH test results
showed that 6 months after IST for 33 (78.8%) patients had PNH clones
below 5%, 5 (15.1%) cases between 5.01% and 10%, and 2 (6.1%) cases
above 10% (range: 44.6%-77.93%). PNH test results were available at
12 months after IST for 32 patients. Totally 28 (87.5%) cases had PNH
clones below 5%, 4 (12.5%) between 5.01% and 10%, and none above
10% (Table 4). In the control group, one patient (2.0%) developed
clonal evolution and progressed to myelodysplastic syndrome(Table 2).