Clonality in hematopoietic disorders

Clonality analysis using the polymorphism of X-linked genes, such as the phosphoglycerate kinase (PGK), hypoxanthine phosphoribosyl transferase (HPRT) genes and CAG repeat of the human androgen receptor (HU-MARA) gene and the hypervariable DXS255 gene have been widely used in the assessment of many hematologic diseases. Monoclonal hematopoiesis was clearly demonstrated in myelodysplastic syndromes (MDS), myeloproliferative disorders (MPD) and leukemia by the X-inactivation analysis. Previous studies also found a higher incidence of monoclonality in aplastic anemia and 'clonal remission' in acute leukemia. However, recent studies have shown that clonal hematopoiesis in aplastic anemia or remission of leukemia is rarer than previously thought when skewed X-inactivation was extensively ruled out by comparison with T-lymphocytes as an internal control. However, a polyclonal pattern obtained by X-inactivation cannot exclude the possibility of a small clonal cell population presenting in aplastic anemia. However, recent studies have demonstrated that residual polyclonal (possibly normal) hematopoietic progenitor cells can be detected in the bone marrow of MDS and MPD patients whose peripheral blood granulocytes showed a monoclonal pattern. This may suggest a novel approach to treatment of these diseases.