Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease.
Lukasz P GondekVivien A SheehanCourtney D FitzhughPublished in: Journal of clinical medicine (2022)
Sickle cell disease (SCD) is associated with severe morbidity and early mortality. Two large population studies found an increased risk for leukemia in individuals with SCD. Notably, while the relative risk of leukemia development is high, the absolute risk is low in individuals with SCD who do not receive cell-based therapies. However, the risk of leukemia in SCD is high after graft rejection and with gene therapy. Clonal hematopoiesis (CH) is a well-recognized premalignant condition in the general population and in patients after high-dose myelotoxic therapies. Recent studies suggest that CH may be more common in SCD than in the general population, outside the cell-based therapy setting. Here, we review risk factors for CH and progression to leukemia in SCD. We surmise why patients with SCD are at an increased risk for CH and why leukemia incidence is unexpectedly high after graft rejection and gene therapy for SCD. Currently, we are unable to reliably assess genetic risk factors for leukemia development after curative therapies for SCD. Given our current knowledge, we recommend counseling patients about leukemia risk and discussing the importance of an individualized benefit/risk assessment that incorporates leukemia risk in patients undergoing curative therapies for SCD.
Keyphrases
- acute myeloid leukemia
- sickle cell disease
- bone marrow
- prognostic factors
- end stage renal disease
- risk assessment
- patients undergoing
- high dose
- ejection fraction
- newly diagnosed
- gene therapy
- chronic kidney disease
- healthcare
- room temperature
- single cell
- peritoneal dialysis
- stem cells
- type diabetes
- low dose
- risk factors
- rectal cancer
- coronary artery disease
- human health
- gene expression
- heavy metals
- mesenchymal stem cells
- human immunodeficiency virus
- replacement therapy
- men who have sex with men
- genome wide analysis