Clonal hematopoiesis of indeterminate potential as a prognostic factor: a systematic review and meta-analysis.

Autor:	Singh J; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Haematology, Fiona Stanley Hospital, Perth, Australia.; Australian Centre for Blood Diseases, Monash University, Melbourne, Australia., Li N; Department of Haematology, Eastern Health, Melbourne, Australia., Ashrafi E; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Thao LTP; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Curtis DJ; Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.; Department of Clinical Haematology, Alfred Health, Melbourne, Australia., Wood EM; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Haematology, Monash Health, Melbourne, Australia., McQuilten ZK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Haematology, Monash Health, Melbourne, Australia.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2024 Jul 23; Vol. 8 (14), pp. 3771-3784.
DOI:	10.1182/bloodadvances.2024013228
Abstrakt:	Abstract: With advances in sequencing, individuals with clonal hematopoiesis of indeterminate potential (CHIP) are increasingly being identified, making it essential to understand its prognostic implications. We conducted a systematic review of studies comparing the risk of clinical outcomes in individuals with and without CHIP. We searched MEDLINE and EMBASE and included original research reporting an outcome risk measure in individuals with CHIP, adjusted for the effect of age. From the 3305 studies screened, we included 88 studies with 45 to 470 960 participants. Most studies had a low-to-moderate risk of bias in all domains of the Quality in Prognostic Factor Studies tool. Random-effects meta-analyses were performed for outcomes reported in at least 3 studies. CHIP conferred an increased risk of all-cause mortality (hazard ratio [HR], 1.34; 95% confidence interval, 1.19-1.50), cancer mortality (HR, 1.46; 1.13-1.88), composite cardiovascular events (HR, 1.40; 1.19-1.65), coronary heart disease (HR, 1.76; 1.27-2.44), stroke (HR, 1.16; 1.05-1.28), heart failure (HR, 1.27; 1.15-1.41), hematologic malignancy (HR, 4.28; 2.29-7.98), lung cancer (HR, 1.40; 1.27-1.54), renal impairment (HR, 1.25; 1.18-1.33) and severe COVID-19 (odds ratio [OR], 1.46; 1.18-1.80). CHIP was not associated with cardiovascular mortality (HR, 1.09; 0.97-1.22), except in the subgroup analysis restricted to larger clones (HR, 1.31; 1.12-1.54). Isolated DNMT3A mutations did not increase the risk of myeloid malignancy, all-cause mortality, or renal impairment. The reasons for heterogeneity between studies included differences in definitions and measurements of CHIP and the outcomes, and populations studied. In summary, CHIP is associated with diverse clinical outcomes, with clone size, specific gene, and inherent patient characteristics important mediators of risk. (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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