SOHO 2026 | ICUS, CHIP, and CCUS: practical approaches to diagnosis, risk stratification, and referral

Yeah, that is really very thoughtful questions. And I think in the community setting the honest question answer is: none of what makes the clinic work requires really like a physical clinic but I think they have several suggestions. First is to finish the workup before we accept the diagnostic label. So the single most common thing that I see the referrals of CCUS is an unexplained cytoenia that was never fully worked up for example the nutrition deficiency, medication review, the medication list. Patients with chronic kidney disease and also like consider autoimmune diseases, I often see patients with LGL that can contribute to their cytoenia. Recently I had another two patients was diagnosed autoimmunity lymphoproliferative disorders. So I think those are, both ICUS and CCUS are diagnosis of exclusion. And the clone doesn’t retroactively explain the cytoenia. So getting this wrong is what generates unnecessary bone marrow biopsies or unnecessary anxiety. And then after we confirm that this is clonal cytoenia then what we could do is to put the risk score in our note is that the existing models gives us an objective quantifiable numbers. It doesn’t need to be perfect and the model have their real limitations. They don’t capture the chromosome architecture well. They don’t predict the overall survival nor other comorbidities. But a documented number is what converts a vague like we will watch it into a defensible surveillance interval. And it is what led us to triage who generally does well with conservative management versus who needs eyes on them. And this will also help us to consider who’s going to need a referrals to academic center. If a patients are truly high- risk that will trigger a real like trigger the referrals. And the third part I think is the part that people often skip and which which is treating the non-malignant risk as the real deliverables. I would like our primary care colleagues to be aware that these clones are inflammatory. They don’t just stay in the bone marrow, it can travel to the tissue, that there is a direct association with atherosclerosis. So statistically patients with CHIP is far more likely to have a cardiovascular events than develop acute leukemia. So lipid management, blood pressure, smoking and a cardiology conversation is probably where the mortality benefit actually sits. And this is also where I often rely on our primary care or cardiologist colleagues. And for those patients are truly high-risk CCUS for heme malignancies, I think that is definitely deserve a referrals. And we are actively developing many of the clinical trials and patient could benefit from the referral and assessment in the academic centers.

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