MDS 2023 | Incidence & clinical significance of clonal hematopoiesis in healthy vs AML patients
Klaus Metzeler, MD, University of Leipzig Medical Center, Leipzig, Germany, discusses the incidence of clonal hematopoiesis (CH) in healthy people and in patients with CH who have progressed to acute myeloid leukemia (AML). Dr Metzeler explains that recent studies have shown that CH is much more common in healthy people than previously thought. In addition, studies have shown that CH persists in patients with AML who are treated with chemotherapy and achieve complete remission (CR), and is also highly frequent in AML survivors. This interview took place at the 17th International Congress on Myelodysplastic Syndromes 2023 (MDS 2023) held in Marseille, France.
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Transcript (edited for clarity)
Yesterday, I was able to show some of our data on clonal hematopoiesis and actually I covered two quite different topics. One was clonal hematopoiesis in older persons with no hematologic disease and we were able to do a study on about 200 individuals there, together with my colleague Katharina Götze from Munich. We found that if we look with a relatively sensitive method, meaning we can detect rather small clones, a little frequency of 1% is the cut-off that we used, cloning hematopoiesis quite more common than you read in some of the other earlier publications on the subject...
Yesterday, I was able to show some of our data on clonal hematopoiesis and actually I covered two quite different topics. One was clonal hematopoiesis in older persons with no hematologic disease and we were able to do a study on about 200 individuals there, together with my colleague Katharina Götze from Munich. We found that if we look with a relatively sensitive method, meaning we can detect rather small clones, a little frequency of 1% is the cut-off that we used, cloning hematopoiesis quite more common than you read in some of the other earlier publications on the subject. We found clonal hematopoiesis in half of our participants with a median age of 70 years. if you look at the age group above the age of 80, actually 85% had clonal hematopoiesis and the literature you often read 10 to 15% above the age of 70. That probably is an underestimate if you also include relatively small clones in the analysis. Now, of course, the question is then or if you look more closely, you probably going to find more clonal hematopoiesis, at what clone size does it become clinically relevant? That’s a different question. In the second part of the talk I was able to look at if you wish, the other end of the spectrum of clonal hematopoiesis those are people who had undergone progression to a myeloid malignancy, specifically AML. Our group has already published a couple of years ago that if an AML patient gets induction chemotherapy and they achieve complete remission, then clonal hematopoiesis often persists in these persons who are in morphological remission. Now in a follow up study, we looked at long-term outcomes of such patients five or more years after the AML therapy, and we found that also in this cohort, clonal hematopoiesis is very common. In fact, if you only received chemotherapy for your AML and no allogeneic transplantation, then 75% of these AML survivors had clonal hematopoiesis. Now we’re starting to investigate what consequences this may have for the health of these persons in terms of, for example, cardiovascular morbidity, because we know clonal hematopoiesis is associated with various inflammatory disorders and we think this is a very interesting cohort to look at and we hope that we’ll get a lot of exciting results from that in the future.
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