Researchers Investigate Impacts of Clonal Hematopoiesis in Patients With Cancer – Renal and Urology News

Effects of clonal hematopoiesis (CH) on patient outcomes, particularly in the setting of a concomitant malignancy, were evaluated in a study reported in the journal Cancer Medicine.

The study investigators aimed to understand impacts of CH on patients, particularly among those who also have malignancies. In this retrospective analysis, the investigators performed assessments of patient characteristics, mutational data, and outcomes from patients with CH who were seen at a tertiary cancer center from January 2015 through March 2021. Analyses of somatic mutations were based on next-generation sequencing conducted using genomic DNA from bone marrow aspirate and/or peripheral blood.

The analysis included 78 patients, and they had a median age at CH diagnosis of 72 years (range, 41-95 years). The majority of patients had cardiovascular comorbidities (73%), and most had a non-myeloid cancer diagnosis (76%). Genomic DNA was collected from bone marrow in 70 patients, with 8 patients having it collected from peripheral blood.

The most common mutations in this analysis were observed in DNMT3A (40%), TET2 (31%), TP53 (26%), and ASXL1 (18%) genes. Cytogenetic data were also available for 71 patients, of whom 77% possessed a normal karyotype, while 10% demonstrated a single chromosomal abnormality.

The median follow-up duration was 27 months (range, 0.1-79 months) from the time of diagnosis. The study population had a 2-year overall survival rate of 79% (95% CI, 70-90), and the median survival time for this population had not been reached. Among 20 reported deaths, 7 (35%) were attributed to a primary cancer, while 4 (20%) were attributed to comorbidities, and 4 (20%) were attributed to myeloid neoplasms after transformation.

Transformation to a myeloid neoplasm was observed in 12 (15%) patients, including to myelodysplastic syndrome/chronic myelomonocytic leukemia in 11 patients and acute myeloid leukemia in 1 patient. When patients were categorized into groups based on CH risk scores, the 3-year cumulative incidence of transformation for patients with low risk was 0%, compared with 15% for patients having intermediate risk (P =.098) and 28% for patients having high risk (P =.05). 

A multivariate analysis identified factors that appeared associated with transformation. These included having a hemoglobin level below 10 g/dL (hazard ratio [HR], 18.25; 95% CI, 3.59-92.73; P =.0005) and having a variant allele frequency of ≥0.2 (HR, 15.62; 95% CI, 3.29-74.05; P =.0005).

“In a population including mostly cancer patients, CH was associated with comorbidities and myeloid transformation in patients with higher mutational burdens and anemia,” the researchers wrote in their report. “Nevertheless, such patients were less likely to die of their myeloid neoplasm than of primary malignancy or comorbidities.”

This article originally appeared on Hematology Advisor