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Review article
Published online: 2021-04-20
Submitted: 2021-01-11
Accepted: 2021-02-15
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The impact of clonal hematopoiesis on outcomes in patients with aplastic anemia

Katarzyna Brzeźniakiewicz-Janus, Joanna Rupa-Matysek, Anna Hoppe, Lidia Gil
DOI: 10.5603/AHP.a2021.0026

open access

Ahead of print
REVIEW ARTICLE
Published online: 2021-04-20
Submitted: 2021-01-11
Accepted: 2021-02-15

Abstract

Over the years, not only have the T-cell mediated immune mechanisms of aplastic anemia (AA) involved in AA development started to become better understood, but there is now also a better understanding of the roles played by somatic mutations, cytogenetic abnormalities and defective telomerase functions and other genetically-related factors.

Somatic gene mutations suggestive of clonal hematopoiesis are detected in approximately one third of patients with AA. Recent studies have suggested that some of these may predict a better response to immunosuppressive therapy, whereas others indicate poorer outcomes with higher risks of clonal evolution to myelodysplastic syndrome or acute myeloid leukemia, and that therefore better results may be obtained based on allogeneic stem cell transplantation. Furthermore, recent advances in molecular techniques may be useful in differentiating aplastic anemia from hypocellular myelodysplastic syndrome and other clonal hematopoiesises of indeterminate potential. All of these are summarized in this review which includes further insights into treatment personalization based on the molecular pathogenesis of AA.

Abstract

Over the years, not only have the T-cell mediated immune mechanisms of aplastic anemia (AA) involved in AA development started to become better understood, but there is now also a better understanding of the roles played by somatic mutations, cytogenetic abnormalities and defective telomerase functions and other genetically-related factors.

Somatic gene mutations suggestive of clonal hematopoiesis are detected in approximately one third of patients with AA. Recent studies have suggested that some of these may predict a better response to immunosuppressive therapy, whereas others indicate poorer outcomes with higher risks of clonal evolution to myelodysplastic syndrome or acute myeloid leukemia, and that therefore better results may be obtained based on allogeneic stem cell transplantation. Furthermore, recent advances in molecular techniques may be useful in differentiating aplastic anemia from hypocellular myelodysplastic syndrome and other clonal hematopoiesises of indeterminate potential. All of these are summarized in this review which includes further insights into treatment personalization based on the molecular pathogenesis of AA.

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Keywords

aplastic anemia, clonal hematopoiesis, outcomes, allogeneic stem cell transplantation

About this article
Title

The impact of clonal hematopoiesis on outcomes in patients with aplastic anemia

Journal

Acta Haematologica Polonica

Issue

Ahead of print

Article type

Review article

Published online

2021-04-20

DOI

10.5603/AHP.a2021.0026

Keywords

aplastic anemia
clonal hematopoiesis
outcomes
allogeneic stem cell transplantation

Authors

Katarzyna Brzeźniakiewicz-Janus
Joanna Rupa-Matysek
Anna Hoppe
Lidia Gil

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