Department of Hematology/Oncology, David Grant USAF Medical Center, Fairfield, CA; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
Semin Oncol. 2022 Feb;49(1):19-26. doi: 10.1053/j.seminoncol.2022.01.009. Epub 2022 Jan 20.
Multiple myeloma (MM) is the second most common hematologic malignancy diagnosed in the United States. With a growing arsenal of novel therapies, patients are living longer and hence are at increased risk of secondary cancers such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). While MDS-associated cytogenetic abnormalities have been described in patients with a diagnosis of for decades, clonal hematopoiesis (CH) has been described only recently. CH has been shown to correlate with inferior survival in MM due to increased risk of disease progression in patients who are treated with high-dose melphalan without lenalidomide maintenance. When involving specific high-risk genes, multiple genes, or when present at high variant allelic frequencies, CH could also potentially elevate the risk of secondary MDS and/or AML, cardiovascular events, and venous thromboembolic events. Despite growing knowledge about CH in patients with MM, many questions remain unanswered. Further studies are needed to better understand the prognostic and therapeutic significance of CH in MM and its precursor conditions, as well as the effect of specific treatments on long-term outcome.
多发性骨髓瘤（MM）是美国第二大常见的血液系统恶性肿瘤。随着新型治疗方法的不断涌现，患者的生存期延长，因此发生继发性癌症（如骨髓增生异常综合征[MDS]和急性髓系白血病[AML]）的风险增加。虽然几十年来一直在描述与 MDS 相关的细胞遗传学异常，但直到最近才描述了克隆性造血（CH）。由于接受不进行来那度胺维持的大剂量马法兰治疗的患者疾病进展风险增加，CH 已被证明与 MM 的生存预后较差相关。当涉及特定的高危基因、多个基因或在高变异等位基因频率下时，CH 也可能增加发生继发性 MDS 和/或 AML、心血管事件和静脉血栓栓塞事件的风险。尽管人们对 MM 患者的 CH 有了更多的了解，但仍有许多问题尚未得到解答。需要进一步的研究来更好地了解 CH 在 MM 及其前体疾病中的预后和治疗意义，以及特定治疗方法对长期结局的影响。
