Multicenter retrospective study of clonal hematopoiesis and therapy-related myeloid neoplasms after autologous transplant for Hodgkin lymphoma

Therapy-related myeloid neoplasm (t-MN) is a life-threatening complication of autologous peripheral blood stem cell transplantation (aPBSCT) for Hodgkin lymphoma (HL). A multicenter retrospective study in the USA investigated the association of presence of clonal hematopoiesis (CH) in the PBSC product and the risk of t-MN. Presence of CH in the PBSC product was an independent predictor of t-MN (aHR 4.50; 95% CI 1.54-13.19). Notably, all patients with TP53 mutations in the PBSC product developed t-MN, whereas none of the patient with DNMT3A mutations alone did. Presence of TP53 and/or PPM1D mutations was associated with a 7.29-fold higher hazard of t-MN when compared to patients carrying no CH mutations (95% CI 1.72-30.94). Presence of TP53 and/or PPM1D mutations was also associated with a 4.17-fold higher hazard of nonrelapse mortality (95% CI 1.25-13.87). The authors conclude that the presence of TP53 and/or PPM1D mutations in the PBSC product was associated with increased risk of post-aPBSCT t-MN and nonrelapse mortality among patients with HL.