Clonal Hematopoiesis and Premalignant Diseases.

Justin Kaner, Pinkal Desai, Nuria Mencia-Trinchant, Monica L Guzman, Gail J Roboz, Duane C Hassane

Cold Spring Harbor perspectives in medicine 2020 Apr 01

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Clonal hematopoiesis (CH) arises when mutations in the hematopoietic system confer a fitness advantage to specific clones, thereby favoring their disproportionate growth. The presence of CH increases with age and environmental exposures such as cytotoxic chemotherapy or radiotherapy. The most frequent mutations occur in epigenetic regulators, such as DNMT3A, TET2, and ASXL1, leading to dysregulation of tumor suppressor function, pathogen response, and inflammation. These dysregulated processes elevate risk of overall mortality, cardiovascular disease, and eventual hematologic malignancy (HM). CH is likely acting as an initiating event leading to HM when followed by cooperating mutations. However, further evidence suggests that CH exerts a bystander influence through its pro-inflammatory properties. Delineating the mechanisms that lead to the onset and expansion of CH as well as its contribution to risk of HM is crucial to defining a management and intervention strategy. In this review, we discuss the potential causes, consequences, technical considerations, and possible management strategies for CH in the context of HMs and pre-HMs. Copyright © 2020 Cold Spring Harbor Laboratory Press; all rights reserved.

Citation

Justin Kaner, Pinkal Desai, Nuria Mencia-Trinchant, Monica L Guzman, Gail J Roboz, Duane C Hassane. Clonal Hematopoiesis and Premalignant Diseases. Cold Spring Harbor perspectives in medicine. 2020 Apr 01;10(4)