What Every Doctor Should Know About Clonal Hematopoiesis

Pinkal Desai, MD, Weill Cornell Medicine, New York, New York, provides the latest updates on clonal hematopoiesis, highlighting what doctors should know about these aging-associated mutations. She provided these insights at the 2022 Lymphoma, Leukemia & Myeloma Congress in New York, New York.

Transcript:

Hi, I’m Dr. Pinkal Desai. I’m a leukemia physician at Weill Cornell Medicine and New York Presbyterian Hospital in New York. I am at the 2022 Lymphoma, Leukemia & Myeloma Congress. There's a lot of fun lectures and talks happening here. I gave a talk on clonal hematopoiesis and what every doctor should know. 

Clonal hematopoiesis refers to the presence of mutations in normal healthy population, as a result of aging. These patients don't have hematologic malignancies, but what is happening with these patients is there is an increased risk of developing hematologic malignancies in the future—and, also, weirdly, cardiovascular diseases—in the future as a result of these aging-associated mutations. Normally we would not find them, but as sequencing is becoming normal, particularly in people who are going through solid malignancy treatment, we can find them.

So where are oncologists encountering these mutations? If somebody has a solid malignancy and the blood is being sequenced as part of a tumor normal, these are incidentally discovered. Or, during workup of some low-grade cytopenias, again, these mutations are discovered, and they don't have actually a blood cancer at that point. 

How do we go about it and what do we do about it? What is important with these mutations is that people who are undergoing, for example, autologous transplantation or chemotherapy for solid malignancies, the presence of these mutations increases risk of future therapy-related myeloid neoplasms. So, if you do have these mutations, these are things that have to be discussed with the patient. And the more we find these mutations, these questions are coming up clinically as to what to do, how to best advise the patient, or [how to advise] the oncologist who is going to administer chemotherapy that it might actually make these mutations grow further, and have a risk of future leukemia.

We also talked about other places this may be relevant and several chronic diseases there that this can be found. And as sequencing efforts become more and more common, even in these benign conditions or chronic diseases, these mutations, we are going to find them. As we treat more and more solid malignancies [and] these people survive their primary cancer, the risk of therapy-related myeloid neoplasms can increase with time. And this is an opportune time to talk about this, because there may be some efforts ongoing or beginning that could prevent these therapy-related myeloid neoplasms, either by not giving them DNA-damaging therapy if the benefit of that is just incremental and small, or by perhaps some novel clinical trials where you could use certain agents that could prevent it. 

Obviously these are huge efforts which will require a lot of follow up and multi-institutional efforts. But it's an opportune time to talk about this, because it's going to become very relevant in the near future.

Source:

Desai P. Debate: Clonal Hematopoiesis: What Every Doctor Needs to Know. Presented at Lymphoma, Leukemia & Myeloma Congress; October 18-22, 2022. New York, NY.