Clonal hematopoiesis in hematopoietic stem cell transplantation

Area of Science:

• Hematology
• Oncology
• Genetics

Background:

• Clonal hematopoiesis (CH) involves mutated stem cell clones without neoplasia.
• CH prevalence increases with age, affecting over 10% of individuals >60.
• CH is linked to higher risks of hematologic cancers and cardiovascular disease.

Purpose of the Study:

• To review the influence of CH on patient outcomes in autologous (ASCT) and allogeneic (allo-HSCT) stem cell transplantation.
• To understand the context-dependent effects of CH in different transplant settings.

Main Methods:

• Review of recent studies investigating CH in HSCT recipients.
• Analysis of outcomes in patients undergoing ASCT and allo-HSCT with and without CH.

Main Results:

• CH is common in allo-HSCT, with no significant negative impact on outcomes, except for increased chronic GvHD.
• In ASCT for lymphoma, CH is associated with excess mortality from therapy-related myeloid neoplasms and cardiovascular events.
• In ASCT for multiple myeloma, CH correlates with inferior survival due to increased disease progression.

Conclusions:

• CH prevalence is high in both ASCT and allo-HSCT, with significant but context-specific impacts on adverse outcomes.
• Current evidence does not support routine CH screening in transplant settings outside clinical trials.
• Further research is needed to clarify CH's role and potential interventions in transplantation.