Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, USA.
DKMS, Dresden, Tübingen, Germany; Department of Internal Medicine, University Hospital Carl Gustav Carus, TU Dresden, Germany.
Blood Rev. 2021 Mar;46:100744. doi: 10.1016/j.blre.2020.100744. Epub 2020 Aug 24.
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.
克隆性造血 (CH) 描述了造血干细胞和祖细胞中的体细胞突变，导致无明显血液系统疾病个体中的克隆性扩增。由于 CH 随年龄的增长而增加，因此了解其在造血细胞移植 (HCT) 中的作用对于老龄化移植人群变得越来越重要。多种因素将移植后造血与未受干扰的稳态造血区分开来，包括免疫抑制剂、细胞毒性试剂和明显的增殖应激的影响，所有这些因素都可能增加或减少克隆扩增的机会。我们回顾了在接受自体 HCT 的患者移植时 CH 的临床后果的现有临床证据，以及供体和受体 CH 对异基因 HCT 结果的影响。在缺乏循证指南的情况下，我们分享了对发现存在 CH 的供体和受体的管理建议。需要开展大规模研究，以指导在 HCT 背景下管理 CH 的循证、统一方法。
