Evolution underlies the transformation of a normal cell to a cancer, yet learning the parameters defining this dynamic process from single-timepoint bulk samples is an open challenge. To understand how cancer cells evolve in vivo, we must rely on naturally occurring, heritable lineage tracing markers that encode the evolutionary history of a population of cells. Here, I shall introduce our work on identifying selectively neutral “epigenetic barcodes” and employing them as a molecular clock. By coupling this process with mathematical modelling and Bayesian inference, we characterised the evolutionary history of almost 2000 lymphoid cancers (Gabbutt et al., 2025). Across a broad range of cancer types, we demonstrated that tumour growth rates and malignancy ages differed by orders of magnitude. In 2 independent cohorts of patients with chronic lymphocytic leukaemia (CLL), a typically indolent and slow growing cancer, the inferred growth rates were highly prognostic. I shall further discuss recent work applying this approach to resolve the clonal relationship between acute myeloid leukaemia (AML) blasts and differentiated neutrophils in patients without bone marrow failure.
