A possible model for clonal evolution in AA. Upon immune-mediated destruction of BM, some clones are thought to be resistant to the inciting autoimmune insult and/or show faster cycling/less apoptosis than others upon BM recovery to achieve a clonal dominance. In some cases, the dominant clones, especially those having DNMT3A, ASXL1, and other unfavorable mutations, increase their clone size, giving rise to more selectively dominant clones therein. In other cases, typically those carrying PIGA mutations (and possibly BCOR/BCOR mutations), initially dominant clones may regress or remain stable over years.