The clinical implications of clonal hematopoiesis in hematopoietic cell transplantation

Mariam T. Nawas, Johannes Schetelig, Frederik Damm, Ross L. Levine, Miguel Angel Perales, Sergio A. Giralt, Marcel R. VanDenBrink, Maria E. Arcila, Ahmet Zehir, Elli Papaemmanuil, Anja Klussmeier, Alexander H. Schmidt, Stephanie Maiwald, Kelly L. Bolton, Roni Tamari

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Clonal hematopoiesis (CH) describes somatic mutations in hematopoietic stem and progenitor cells resulting in clonal expansion in individuals with no overt hematologic disease. Since CH increases in an age-related manner, understanding its role in hematopoietic cell transplantation (HCT) has become increasingly relevant to an aging transplant population. Multiple factors distinguish post-transplant hematopoiesis from unperturbed, steady-state hematopoiesis, including the influence of immunosuppressants, cytotoxic reagents, and marked proliferative stress, all of which may enhance or diminish the opportunity for clonal expansion. We reviewed the available clinical evidence on the consequences of CH at time of transplant in patients undergoing autologous HCT, and the impact of donor and recipient CH on allogeneic HCT outcomes. In the absence of evidence-based guidelines, we share our suggestions for managing donors and recipients found to have CH. Large-scale studies are needed to guide an evidence-based, uniform approach for the management of CH in the setting of HCT.

Original languageEnglish
Article number100744
JournalBlood Reviews
Volume46
DOIs
StatePublished - Mar 2021

Keywords

  • Age-related clonal hematopoiesis
  • Allogeneic transplantation
  • Autologous transplantation
  • Clonal hematopoiesis
  • Donor-derived
  • Hematopoietic stem cell

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