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Impact of Donor Clonal Hematopoiesis on Stem Cell Transplantation

By: Sarah Campen, PharmD
Posted: Wednesday, January 2, 2019

The eligibility of allogeneic hematopoietic stem cell transplantation (HSCT) from donors with clonal hematopoiesis of indeterminate potential (CHIP) has been controversial, as little is known about the impact of CHIP status on the outcome of the recipient. Recently, in an exploratory study published in the Journal of Clinical Oncology, researchers found that receiving an allograft from a CHIP donor appears to be safe and may result in similar overall survival in the setting of older and related donors.

CHIP occurs in the blood of approximately 20% of older persons and is linked to an increased risk of hematologic malignancies and all-cause mortality. This study included 500 healthy, related donors age 55 or older; clonal mutations were identified in 80 donors (16.0%). In recipients allografted with donor CHIP, researchers found a higher cumulative incidence of chronic graft-versus-host disease (P = .003) but a lower cumulative incidence of relapse or disease progression (P = .042). Overall survival was not affected by CHIP status. Notably, the prevalence of the condition was higher in donors related to patients with myeloid compared with lymphoid malignancies (19.2% vs. 6.3%; P ≤ .001).

“Future studies in younger and unrelated donors are warranted to extend these results,” stated Frederik Damm, MD, of Charité, University Medical Center Berlin, Germany, and colleagues. “Confirmatory studies and mechanistic experiments are warranted to challenge the hypothesis that donor CHIP might foster [chronic graft-versus-host disease] development and reduce relapse/progression risk.”

Disclosure: Study authors’ disclosure information may be found at Journal of Clinical Oncology.

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