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MYELODYSPLASTIC NEOPLASM

Clinicopathologic characteristics and outcomes of patients with clonal hematopoiesis who progress to myeloid neoplasms

Leukemia volume 39, pages 1269–1272 (2025)Cite this article

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Clonal hematopoiesis (CH) is a non-malignant clonal expansion of a hematopoietic stem cell population due to the acquisition of somatic mutation(s) that confer advantages in self-renewal and proliferation. These mutations have been detected in healthy individuals and rise in frequency with normal aging [1]. The increase in prevalence of CH with age may reflect the cumulative effect of exposures to environmental stressors, such as radiation, tobacco, and mutagenic drugs, that provide selective pressure for particular hematopoietic stem cells and consequent clonal expansion [2]. Although its presence does not directly lead to oncologic disease, CH has been associated with an increased risk of hematologic malignancies and myeloid neoplasms (MNs), chronic inflammation, and cardiovascular complications [3].

The Clonal Hematopoiesis Risk Score (CHRS) is a personalized prediction tool incorporating age, peripheral blood laboratory values, specific mutations, and variant allele frequency (VAF) to assess the risk of progression to MNs in healthy adults with CH [4]. The impact of medical histories, especially prior cancer diagnosis and exposure to antineoplastic therapy, is not included. Additionally, although it is well established that CH increases risk of MN transformation, the dynamics of disease evolution in patients with CH who progress to MNs remain unknown. Thus, we aimed to evaluate the clinicopathologic characteristics and survival outcomes of patients with MN with known antecedent CH, with a particular focus on patients with prior non-myeloid malignancies.

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Fig. 1: Survival outcomes and genomic evolution of patients from clonal hematopoiesis (CH) to myeloid neoplasms (MNs).

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Acknowledgements

This research was supported in part by the University of Texas MD Anderson Cancer Center Support Grant CA016672. This manuscript was edited by scientific editor Sarah J. Bronson of the Research Medical Library at The University of Texas MD Anderson Cancer Center.

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Author notes

  1. These authors contributed equally: Kelly S. Chien, Julie S. Braish.

Authors and Affiliations

  1. Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kelly S. Chien, Julie S. Braish, Alex Bataller, Guillermo Montalban-Bravo, Koji Sasaki, Koichi Takahashi, Courtney D. DiNardo, Mahesh Swaminathan, Hagop M. Kantarjian & Guillermo Garcia-Manero

  2. Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ziyi Li

  3. Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sanam Loghavi & Rashmi Kanagal-Shamanna

Authors
  1. Kelly S. Chien
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  2. Julie S. Braish
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Contributions

Contribution: KSC, JB, ZL, SL, AB, GM-B, KS, and RK-S collected and analyzed data; KSC, JB, ZL, and AB created the tables and figures; KSC, JB, and GG-M designed the study and wrote the manuscript; KT, CDD, MS, and HMK provided scientific input during the research project; all authors edited and approved the final manuscript.

Corresponding author

Correspondence to Kelly S. Chien.

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The authors declare no competing interests.

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This data has been presented in part at the 2024 American Society of Clinical Oncology Annual Meeting (Chicago, IL, USA), 2024 European Hematology Association Annual Congress (Madrid, Spain), and 2024 Society of Hematologic Oncology Annual Meeting (Houston, TX, USA).

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Chien, K.S., Braish, J.S., Li, Z. et al. Clinicopathologic characteristics and outcomes of patients with clonal hematopoiesis who progress to myeloid neoplasms. Leukemia 39, 1269–1272 (2025). https://doi.org/10.1038/s41375-025-02564-z

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