Dr. Coombs Spotlights Recent CHIP Updates

Catherine Coombs, MD, an Associate Professor in the Division of Hematology/Oncology at the University of California, Irvine, School of Medicine, highlights recent studies in clonal hematopoiesis of indeterminate potential (CHIP) presented at the 65th American Society of Hematology Annual Meeting & Exposition in the fourth episode of the second season of “The HemOnc Pulse.”

Dr. Coombs discussed research (abstract #937) on reversing the adverse effects of CHIP, particularly its association with atherosclerotic cardiovascular disease, using interventions such as eltanexor, a selective nuclear export inhibitor.

“My hope is that if this ever goes into human trials, CHIP has … to be well tolerated,” she said. “I don’t know a ton about the drug. I have seen selinexor dating back to phase I trials, and [it] certainly [is] not the most benign drug with respect to its toxicity. Nonetheless, this is a newer version of that drug. If they could find a way to make it a very well-tolerated drug, I think it could be interesting.”

She also illustrated another study (abstract #784) that looks at the prevalence of CHIP in patients undergoing autologous hematopoietic stem cell transplant (AHSCT) in lymphoma, which showed an increased risk of cardiovascular disease and lower survival rates.

“I think the interesting findings were that the patients who had CHIP who underwent [AHSCT] had a higher cumulative incidence of cardiovascular disease compared with the patients without CHIP,” she said. “In addition, the presence of CHIP was associated with shorter survival than patients without CHIP. [There] may be an added risk factor to outcomes with [AHSCT], not only with respect to overall survival, which has been seen in other trials, but also with respect to some of the cardiovascular complications that can occur.”

In light of these results and other recent oncology studies, it might be useful to have the risk-benefit discussion, she explained.

“I wouldn’t draw a conclusion saying they shouldn’t get whatever intervention they need for their cancer,” she explained. “I’m of the belief that you have to treat the cancer you know you have as opposed to the one you may get downstream with having an increased risk of hematologic malignancies, but also these other downstream complications. Obviously, there’s the immediate issue, but I think it is helpful in informing wait-term toxicity to learn more about these patients.”