Yeah. So one of the things that the CHRS allows us to do in clinics is for populations of patients who either because they’re on a research study or because they have gene testing for something else, for hereditary cancer syndromes or for their solid malignancy, patients who are found to have clonal hematopoiesis, we’re now able to counsel those patients on what that means, so what their risk of progression is in a very generalizable sort of way...
Yeah. So one of the things that the CHRS allows us to do in clinics is for populations of patients who either because they’re on a research study or because they have gene testing for something else, for hereditary cancer syndromes or for their solid malignancy, patients who are found to have clonal hematopoiesis, we’re now able to counsel those patients on what that means, so what their risk of progression is in a very generalizable sort of way. What we don’t advise is that patients get individuals who are just adults just randomly get screened for clonal hematopoiesis. And that’s because we don’t yet have any tools in our arsenal to actually eradicate CH or things that we know will mitigate the risk of blood cancer down the line. So outside of the context of a research study, screening for clonal hematopoiesis is actually premature.
And so what I would suggest to patients is that if you already know that you have CHIP or CCUS, it’s worth it to talk to a provider about your CHIP or CCUS status and get a sense of what your individual risk is if you would like to know. And based on the CHRS or even some of the other risk tools that are available, your clinician should be able to sort of chart out with you a sort of personalized surveillance strategy for how often you should get blood counts rechecked, whether or not you need a bone marrow biopsy and that sort of thing, where individuals who are high risk, that’s where we would do more intervention or more surveillance, and individuals who are low risk probably could do without much surveillance or much sort of intervention or invasive diagnostic testing.
In terms of actual therapeutic interventions, you know, I think all of the therapeutic interventions that are available to individuals with CCUS right now, short of, you know, erythropoietin agonists or TPO mimetics that sort of stimulate your bone marrow to make more red blood cells or platelets, short of those things, the therapies that are available are available in the context of clinical trials. And so I would suggest that a patient who is interested in clinical trials and is eligible for a clinical trial talk to their providers about being involved in a clinical trial if that’s of interest, but there are no therapies per se that, you know, can be prescribed as sort of regulatory element approved agents for the treatment of CHIP and CCUS. And individuals with CHIP and CCUS, we are aware, don’t have full-blown malignancy as of yet. And so, you know, a lot of what we do and what we suggest to patients is surveillance and management of their cytopenias or low blood counts.
The other thing to sort of keep in mind about CHIP and CCUS is that it also increases your risk for non-malignant comorbidities. And so one of the things that we do in our CHIP clinic is advise that patients who have other cardiovascular disease risk factors and have CHIP, you know, talk to their primary care doctors or preventative cardiologists about what they can do to prevent their risk of cardiovascular disease, which individuals with CHIP and CCUS have a higher risk for cardiovascular disease than individuals without CHIP and CCUS. And so those are the things that we’re sort of thinking about now. It’s mostly in the context of clinical research and there are no real proven therapies that we offer patients outside of the clinical research setting at this time.
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