Transplantation for Myeloma: Outcomes for Patients With Clonal Hematopoiesis
Posted: Thursday, August 20, 2020
The presence of clonal hematopoiesis of indeterminate potential (CHIP) appears to be associated with adverse outcomes for patients with multiple myeloma who are undergoing autologous stem cell transplantation, according to a study published in Nature Communications. However, Irene M. Ghobrial, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues explained that further prospective clinical trials may be warranted to examine the interaction among CHIP mutations, autologous stem cell transplantation, and immunomodulatory maintenance therapies in these patients.
“Our findings indicate that the presence of CHIP at the time of transplant is a risk factor for faster disease progression,” commented study coauthor Tarek H. Mouhieddine, MD, also of Dana-Farber, in a press release. “This might suggest that patients should be screened for CHIP in advance of a transplant, but our data also show that immunomodulatory therapy after a transplant is safe regardless of CHIP status.”
The investigators compiled clinical data from 629 patients with multiple myeloma who underwent autologous stem cell transplantation between 2003 and 2011. Additionally, peripheral blood and bone marrow samples were collected for laboratory assessments.
Based on the results of targeted sequencing, CHIP mutations were detected in 21.6% of patients. In this patient population, DNMT3A, TET2, TP53, ASXL1, and PPM1D were the most commonly mutated genes. Of the 56 patients who received first-line immunomodulatory maintenance therapy, 21 developed a therapy-related myeloid neoplasm. Immunomodulatory maintenance therapy seemed to be associated with improved progression-free and overall survival, irrespective of CHIP status. CHIP mutations appeared to be associated with decreased progression-free (hazard ratio = 1.45; P < .001) and overall (hazard ratio = 1.34; P = .02) survival in patients who did not receive immunomodulatory maintenance therapy.
Disclosure: For full disclosures of the study authors, visit www.nature.com.
