Clinical significance of clonal diversity in AML. (A) Comparison of clonal richness quantified by using the Menhinick index and change in clonal diversity from diagnosis to remission quantified according to the Simpson index based on patient response. (The circle indicates an outlier.) (B) Cox proportional regression model comparing clonal richness, change in clonal diversity, age, sex, and the 2017 ELN risk category. The ELN risk categories are compared with favorable risk. P values were calculated based on the Wald test. (C) Kaplan-Meier analysis showing RFS of 14 de novo AML patients stratified according to change in diversity at remission compared with diagnosis. P value was calculated by using the log-rank test. (D) Schema for future single-cell MRD-guided clinical strategies. *P value of .03 is significant (P < .05). Adv, adverse; allo-HCT, allogeneic hematopoietic cell transplant; Int, intermediate.