General Updates | CHIP clinics: providing comprehensive care and facilitating research integration

So, CHIP clinics are highly specialized clinics that aim to bring comprehensive care to patients with these precursor conditions, as well as aim to conduct original investigation to help move the science forward. And there’s at least 15 CHIP clinics across the U.S. Some of these CHIP clinics include places such as Vanderbilt, Dana-Farber Cancer Institute, NYU, Moffitt Cancer Center, UMass, the Mayo Clinic, University of Chicago, Stanford, UCSF, Sloan-Kettering. And some of the CHIP clinics have distinct physical locations, while others might be actually just branches within central hematology or oncology clinics or branches within cardiovascular medicine clinics. CHIP clinics often receive referrals through the lens of classical hematology, where advanced practice practitioners might be seeing patients with cytopenias or other hematologic-specific symptoms. So from there, bone marrow biopsies are often performed as part of the diagnostic workup for cytopenias or these heme symptoms or B symptoms, and the patient might be found to have CHIP in the real-world setting. Identification of patients may be also done prospectively or even retrospectively. For retrospective identification of patients, IRB protocols should generally be in place to ensure protection of human subjects. 

Now, for the key personnel in CHIP clinics, CHIP clinic personnel might include a variety of people, such as a hematologist, a cardiologist, a hematopathologist, a molecular pathologist, even a genetic counselor, a primary care physician who might be able to manage the various comorbidities that are linked with CHIP, and a health psychologist. But by no means is this a comprehensive list of the critical personnel. 

And in terms of operational workflows, one of the major utilities of CHIP clinics is data-driven risk assessment using the three main models of CHIP risk assessment, including the MN PREDICT, the clonal hematopoiesis risk score, and the clonal cytopenia risk score. So with regard to original investigation, research in CHIP can be seamlessly integrated with clinical care if the right structural support is available for such efforts. And well-annotated research registry of real-world patients, as well as tissue biorepositories, might be able to pave the way for cutting-edge science in the field. I think data curation from CHIP clinics may include assessment of various variables, such as socioeconomic factors, along with cytogenetic and genomic information, and true clinical trajectories. CHIP clinics may also offer clinical trial opportunities for patients who are looking to mitigate their risk for progression to overt myeloid neoplasm. So I’m really looking forward to seeing more multidisciplinary, multi-institutional collaboration in the field as we move forward. And I think as a team studying CHIP, we have not only been able to gain insight into the early steps for MDS and AML pathogenesis, but we also have the ability to shape the future of preventive medicine and positively influence tens of thousands of people worldwide.

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