The clonal trajectories to blood cancers are largely unknown. While it has been known for a while that many childhood leukemias originate before birth, it is now becoming evident that this may also be true for certain leukemias that present in adult life. What predisposes hematopoietic cells to acquire oncogenic mutations in utero, and why do only some of these preleukemic clones transform to full blown leukemia, with others not progressing? The variable latency of malignant transformation for different leukemias is also a matter of interest, as it might allow screening, monitoring and possible intervention in those born with preleukemic clones.

Dr. Anindita Roy will speak about how childhood leukemias, especially those in infants, originate before birth. In this talk she will highlight the importance of fetal specific progenitors and their molecular programs in human hematopoiesis, and how they determine the biology of MLL-AF4+ infant acute lymphoblastic leukemia. She will also explore whether it is possible to use this information to understand the origins and refractory nature of infant leukemia, with the aim of developing better therapeutic strategies.

Dr. Jyoti Nangalia will discuss how adult blood cancers and clonal expansions can also originate in childhood, including before birth. She will highlight what factors might determine their long clonal trajectories such that disease occurs many decades later. She will explore what is known about clonal trajectories across blood cancers and potential opportunities for earlier detection and interventional strategies.