Fig. 4
From: The telomere maintenance mechanism spectrum and its dynamics in gliomas
a Sankey plot indicating changes in the telomerase maintenance mechanism (TMM) between initial and matched progressed samples. Line colors refer to the treatment conducted. RT, radiotherapy; CT, chemotherapy; Observation, surgery only. The horizontal axis indicates the average progression-free survival time (in days) of patients in each TMM group. b Changes in the relative telomerase activity (RTA) under each TMM switching condition. Line colors denote the RTA change (red, increase; blue, decrease; black, no change). c Panoramic view of all 64 cases of longitudinal samples showing TMM switching and RTA changes. Four cases (“asterisk”) showed changes in the mutational status of the TERT promoter (Tp) or ATRX loss (A) during progression. d Changes in the TMM, RTA, and gene expression in 7 cases of natural progression without any intervening treatment between the initial and recurrent samples. Gene expression changes in this switching sample series validated the identified negative-specific TMM genes and cell cycle/division-related genes in cases in the telomerase group with an evident RTA increase. Quantitative clonal evolution diagrams during progression showed an increased number of clones with an RTA increase at progression