Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease
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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/11/3160 |
| _version_ | 1797492892458024960 |
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| author | Lukasz P. Gondek Vivien A. Sheehan Courtney D. Fitzhugh |
| author_facet | Lukasz P. Gondek Vivien A. Sheehan Courtney D. Fitzhugh |
| author_sort | Lukasz P. Gondek |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T01:11:13Z |
| format | Article |
| id | doaj.art-582b1a0d7adf4ac18eb8f8a3f55aeb4c |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:11:13Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-582b1a0d7adf4ac18eb8f8a3f55aeb4c2023-11-23T14:17:50ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011111316010.3390/jcm11113160Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell DiseaseLukasz P. Gondek0Vivien A. Sheehan1Courtney D. Fitzhugh2Department of Oncology, Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, CRB1-290, 1650 Orleans Street, Baltimore, MD 21287, USADepartment of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USACellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, NIH, 10 Center Drive, Bethesda, MD 20814, USASickle 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.https://www.mdpi.com/2077-0383/11/11/3160sickle cell diseaseleukemiaallogeneichematopoietic cell transplantgene therapyclonal hematopoiesis |
| spellingShingle | Lukasz P. Gondek Vivien A. Sheehan Courtney D. Fitzhugh Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease Journal of Clinical Medicine sickle cell disease leukemia allogeneic hematopoietic cell transplant gene therapy clonal hematopoiesis |
| title | Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease |
| title_full | Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease |
| title_fullStr | Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease |
| title_full_unstemmed | Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease |
| title_short | Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease |
| title_sort | clonal hematopoiesis and the risk of hematologic malignancies after curative therapies for sickle cell disease |
| topic | sickle cell disease leukemia allogeneic hematopoietic cell transplant gene therapy clonal hematopoiesis |
| url | https://www.mdpi.com/2077-0383/11/11/3160 |
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