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Age-related clonal hematopoiesis associated with adverse outcomes.

作者信息

Jaiswal Siddhartha, Fontanillas Pierre, Flannick Jason, Manning Alisa, Grauman Peter V, Mar Brenton G, Lindsley R Coleman, Mermel Craig H, Burtt Noel, Chavez Alejandro, Higgins John M, Moltchanov Vladislav, Kuo Frank C, Kluk Michael J, Henderson Brian, Kinnunen Leena, Koistinen Heikki A, Ladenvall Claes, Getz Gad, Correa Adolfo, Banahan Benjamin F, Gabriel Stacey, Kathiresan Sekar, Stringham Heather M, McCarthy Mark I, Boehnke Michael, Tuomilehto Jaakko, Haiman Christopher, Groop Leif, Atzmon Gil, Wilson James G, Neuberg Donna, Altshuler David, Ebert Benjamin L

机构信息

The authors' affiliations are listed in the Appendix.

出版信息

N Engl J Med. 2014 Dec 25;371(26):2488-98. doi: 10.1056/NEJMoa1408617. Epub 2014 Nov 26.


DOI:10.1056/NEJMoa1408617
PMID:25426837
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4306669/
Abstract

BACKGROUND: The incidence of hematologic cancers increases with age. These cancers are associated with recurrent somatic mutations in specific genes. We hypothesized that such mutations would be detectable in the blood of some persons who are not known to have hematologic disorders. METHODS: We analyzed whole-exome sequencing data from DNA in the peripheral-blood cells of 17,182 persons who were unselected for hematologic phenotypes. We looked for somatic mutations by identifying previously characterized single-nucleotide variants and small insertions or deletions in 160 genes that are recurrently mutated in hematologic cancers. The presence of mutations was analyzed for an association with hematologic phenotypes, survival, and cardiovascular events. RESULTS: Detectable somatic mutations were rare in persons younger than 40 years of age but rose appreciably in frequency with age. Among persons 70 to 79 years of age, 80 to 89 years of age, and 90 to 108 years of age, these clonal mutations were observed in 9.5% (219 of 2300 persons), 11.7% (37 of 317), and 18.4% (19 of 103), respectively. The majority of the variants occurred in three genes: DNMT3A, TET2, and ASXL1. The presence of a somatic mutation was associated with an increase in the risk of hematologic cancer (hazard ratio, 11.1; 95% confidence interval [CI], 3.9 to 32.6), an increase in all-cause mortality (hazard ratio, 1.4; 95% CI, 1.1 to 1.8), and increases in the risks of incident coronary heart disease (hazard ratio, 2.0; 95% CI, 1.2 to 3.4) and ischemic stroke (hazard ratio, 2.6; 95% CI, 1.4 to 4.8). CONCLUSIONS: Age-related clonal hematopoiesis is a common condition that is associated with increases in the risk of hematologic cancer and in all-cause mortality, with the latter possibly due to an increased risk of cardiovascular disease. (Funded by the National Institutes of Health and others.).

摘要

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本文引用的文献

[1]
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Proc Natl Acad Sci U S A. 2014-2-3

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