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Clonal Hematopoiesis of Indeterminate Potential at Time of ASCT May Be Linked to Adverse Outcomes in Lymphoma

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Key Points

  • Clonal hematopoiesis of indeterminate potential at the time of ASCT was found in 30% of patients with lymphoma.
  • Clonal hematopoiesis of indeterminate potential at ASCT was associated with an increased risk of therapy-related myeloid neoplasm and poorer overall survival.

In a study reported in the Journal of Clinical Oncology, Gibson et al found that clonal hematopoiesis of indeterminate potential at the time of autologous stem cell transplantation (ASCT) in patients with lymphoma was associated with an increased risk of poorer outcomes.

Study Details

In the study, whole-exome sequencing was performed on pre- and post-ASCT samples from 12 patients who had therapy-related myeloid neoplasm (myelodysplastic syndromes or acute myeloid leukemia) after ASCT for Hodgkin or non-Hodgkin lymphoma. Targeted sequencing was performed on cryopreserved samples of ASCT products from 401 patients who had ASCT for non-Hodgkin lymphoma between 2003 and 2010.

Poorer Outcomes

Mutations present in therapy-related myeloid neoplasm specimens were also identified in pre-ASCT specimens in 6 of 12 patients in the exome-sequencing cohort. In the targeted sequencing cohort, 120 patients (29.9%) had clonal hematopoiesis of indeterminate potential at the time of ASCT.

Compared with patients without clonal hematopoiesis of indeterminate potential at ASCT, these patients had an increased risk of therapy-related myeloid neoplasm (10-year cumulative incidence = 14.1% vs 4.3%, P = .002) and significantly poorer overall survival (10-year overall survival = 30.4% vs 60.9%, P < .001), including an increased risk of death from therapy-related myeloid neoplasm (5- and 10-year cumulative incidence rates = 2.6% vs 0.4% and 7.6% vs 0.4%, P = .001) and death from cardiovascular disease (5-year cumulative incidence rate = 4.3% vs 0.3%, P = .03).

The investigators concluded: “In patients undergoing ASCT for lymphoma, [clonal hematopoiesis of indeterminate potential] at the time of transplantation is associated with inferior survival and increased risk of [therapy-related myeloid neoplasm].”

The study was supported by the Wong Family Foundation, Conquer Cancer Foundation, Dana-Farber Cancer Institute, National Institutes of Health grants, Leukemia and Lymphoma Society, V Foundation, and Nesvig Foundation.

Benjamin L. Ebert, MD, PhD, of Brigham and Women’s Hospital, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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