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Emerging patterns in clonal haematopoiesis
  1. Jose-Mario Capo-Chichi1,
  2. Phillip Michaels2,
  3. Rosemarie Tremblay-Le May2,
  4. Sagi Abelson3,4,
  5. Robert Paul Hasserjian5,
  6. Daniel Xia2
  1. 1Department of Molecular Genetics, Toronto General Hospital, Toronto, Ontario, Canada
  2. 2Department of Pathology, University Health Network, Toronto, Ontario, Canada
  3. 3Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  4. 4Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  5. 5Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
  1. Correspondence to Dr Daniel Xia, Pathology, University Health Network, Toronto, ON M5G 2C4, Canada; daniel.xia{at}


Clonal haematopoiesis (CH) is defined by the presence of acquired mutations and/or cytogenetic abnormalities in haematopoietic cells. By definition, these premalignant clones do not meet criteria for haematopoietic neoplasms listed in the Revised Fourth Edition of the WHO classification. CH is fairly common in elderly individuals and is associated with higher risks for haematological cancers, in particular myelodysplastic syndrome and acute myeloid leukaemia (AML), as well as cardiovascular events. Similar small clones have also been detected during follow-up in patients with AML in morphological remission, in individuals with aplastic anaemia, and in pre-chemotherapy blood samples from patients with other types of cancers. In each of these contexts, the presence of mutations carries different clinical implications, and sometimes demonstrates unique genetic profiles. Emerging research suggests that the number and identity of mutations, the size of the mutant clones and various other factors, including age, immune status and history of exogenous drugs/toxins, are important for disease biology and progression. This review focuses specifically on the subset of CH with gene mutations detected by sequencing, and includes discussions of nomenclature and molecular technologies that detect and quantify gene mutations.

  • molecular genetics
  • leukocytes
  • haematopathology

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  • J-MC-C, PM and RT-LM contributed equally.

  • Handling editor Runjan Chetty.

  • Contributors JC, PM, RTL and DX contributed to the conception, drafting and revising of the manuscript. SA and RPH provided critical feedback and revised the manuscript. All authors approve the version of the manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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