Clinical management of clonal hematopoiesis

Abstract

Clonal hematopoiesis, particularly clonal hematopoiesis of indeterminate potential and clonal cytopenia of undetermined significance, is an age-related premalignant condition characterized by the expansion of hematopoietic clones carrying somatic mutations. Because of the accessibility of peripheral blood, it has been increasingly detected, even in otherwise healthy individuals. Although often asymptomatic, specific clonal hematopoiesis–associated mutations and clonal features are associated with an increased risk of progression to hematologic malignancies, including myelodysplastic syndromes and acute myeloid leukemia. Beyond malignant transformation, clonal hematopoiesis also has systemic implications and has been linked to a variety of nonmalignant conditions, such as cardiovascular and inflammatory disease. In this review, we focus on the clinical management of clonal hematopoiesis, including approaches to diagnosis, tools for risk stratification, and strategies for surveillance and comorbidity mitigation. In the absence of consensus guidelines and approved therapies, management remains individualized, underscoring the need for continued research and clinical trials to guide evidence-based care and improve patient outcomes.