van Zeventer I A, Buisman S C, de Graaf A O, de Haan G, Jansen J H, Huls G
UMCG, afd. Hematologie, Groningen.
UMCG, European Research Institute for the Biology of Ageing, Groningen.
Ned Tijdschr Geneeskd. 2020 Nov 5;164:D5205.
Upon ageing, hematopoietic stem or progenitor cells harboring acquired leukemia-associated mutations may expand clonally and become detectable in peripheral blood. So-called clonal hematopoiesis may be detected in 5-55% of (otherwise healthy) individuals aged ≥ 70 years. Clonal hematopoiesis is associated with a higher risk of developing hematological neoplasms, although most individuals never develop malignant disease. Surprisingly, clonal hematopoiesis is also recognized as a new cardiovascular risk factor. Specific patient categories may be at higher risk for the consequences of clonal hematopoiesis. For future risk stratification, there is a need to distinguish high-risk clonal hematopoiesis from 'physiological' ageing processes. In this article we summarize current knowledge on clonal hematopoiesis and its clinical implications. Given the widespread application of next-generation sequencing in routine diagnostics, multidisciplinary recommendations for clinical management of individuals with detected clonal hematopoiesis should be developed.
随着年龄增长，携带获得性白血病相关突变的造血干细胞或祖细胞可能会克隆性扩增，并在外周血中被检测到。在70岁及以上（其他方面健康）的个体中，5%-55%可能检测到所谓的克隆性造血。克隆性造血与发生血液系统肿瘤的风险较高相关，尽管大多数个体从未发生恶性疾病。令人惊讶的是，克隆性造血也被认为是一种新的心血管危险因素。特定患者类别可能因克隆性造血的后果而面临更高风险。为了未来的风险分层，有必要将高危克隆性造血与“生理性”衰老过程区分开来。在本文中，我们总结了关于克隆性造血及其临床意义的当前知识。鉴于下一代测序在常规诊断中的广泛应用，应制定针对检测到克隆性造血个体的临床管理的多学科建议。
