Ann Lab Med 2019; 39(6): 509-514  https://doi.org/10.3343/alm.2019.39.6.509
Current Aspects of Clonal Hematopoiesis: Implications for Clinical Diagnosis
Kristin Karner, M.D., Tracy I. George, M.D., and Jay L. Patel, M.D., M.B.A.
Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, UT, USA
Corresponding author: Tracy I. George, M.D.
Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84124, USA
Tel: +1 (801)-584-5240 Fax: +1 (801)-584-5124 E-mail: tracy.george@path.utah.edu
Received: January 10, 2019; Revised: February 11, 2019; Accepted: June 9, 2019; Published online: November 1, 2019.
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Abstract
The broad dissemination of next-generation sequencing capability has increased recognition of clonal hematopoiesis in various clinical settings. In hematologically normal individuals, somatic mutations may occur at an increasing frequency with age in genes that are also commonly mutated in overt myeloid malignancies such as AML and MDS (e.g., DNMT3A, TET2, and ASXL1). This is referred to as clonal hematopoiesis of indeterminate potential (CHIP) and is a benign state; however, it carries a risk of progression to hematologic malignancy as well as mortality primarily because of increased cardiovascular events. In clinical settings, clonal hematopoiesis may be observed in cytopenic patients who do not otherwise meet the criteria for hematologic malignancy, a condition referred to as clonal cytopenias of undetermined significance (CCUS). Distinguishing CCUS from overt MDS or other myeloid neoplasms can be challenging because of the overlapping mutational landscape observed in these conditions. Genetic features that could be diagnostically helpful in making this distinction include the number and biological function of mutated genes as well as the observed variant allele frequency. A working knowledge of clonal hematopoiesis is essential for the diagnosis and clinical management of patients with hematologic conditions. This review describes the key characteristics of clonal hematopoiesis with particular focus on implications for differential diagnosis in patients with CHIP, idiopathic cytopenia, CCUS, and myeloid malignancy.
Keywords: Clonal hematopoiesis, Clonal hematopoiesis of indeterminate potential, Idiopathic cytopenias of undetermined significance, Clonal cytopenias of undetermined significance



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