Acute myeloid leukemia (AML) is an aggressive hematopoietic malignancy
with an exceedingly poor prognosis, showing a 5-year overall survival rate of
40–45% in the young and a 5-year survival rate of below
10% in the elderly (>60y). Though a high percentage of patients
enter complete remission following chemotherapeutic intervention, the majority
of patients relapse within three years. Such stark prognostic outcomes highlight
the need for additional clinical research, basic discovery, and molecular
delineation of the etiologies and mechanisms behind responses to therapy that
lead to relapse. Here we summarize recent discoveries in tumor heterogeneity at
the genetic and epigenetic levels, and their independent molecular trajectories
and dynamics in response to therapy. These new discoveries may have significant
implications for understanding, monitoring, and treating leukemia and other
cancers.