An Autologous Stem Cell Transplant (ASCT) is a component of the FDA standard-of-care therapy plan for all newly diagnosed myeloma patients. An ASCT is high dose, aggressive chemotherapy.
As a medical procedure, an ASCT is a lot of toxicity and is hard on the myeloma patient’s heart. In fact, if you have clonal hematopoiesis of indeterminate potential (CHIP) and have an ASCT, there is a good chance that you will develop cardiovascular disease (CVD).
Hematopoietic cell transplant aka the procedure referred to as a stem cell transplant, either allogeneic or autologous, is high-dose therapy, is aggressive and therefore hard on the myeloma patient’s heart.
What is CHIP?
Clonal hematopoiesis of indeterminate potential (CHIP) is a condition characterized by the presence of genetically distinct populations of blood cells, specifically in the hematopoietic (blood-forming) system. It involves the acquisition of somatic mutations in hematopoietic stem cells or early progenitor cells, leading to the expansion of a clone of cells with these mutations.
In CHIP, these mutations are often found in genes associated with myeloid malignancies, such as leukemia. However, individuals with CHIP do not necessarily develop leukemia or any other blood cancer. Instead, CHIP is associated with an increased risk of cardiovascular events, such as heart attacks and strokes.
The term “indeterminate potential” reflects the uncertainty about the clinical outcomes associated with CHIP. While it is a risk factor for certain health issues, not everyone with CHIP will go on to develop a blood cancer or experience cardiovascular events. Researchers are actively studying CHIP to better understand its implications and to identify strategies for monitoring and managing individuals with this condition.
It’s important to note that CHIP is more common in older individuals, and its prevalence tends to increase with age. Regular monitoring and further research are essential to better understand the clinical significance of CHIP and develop appropriate interventions for those at risk.
What is an ASCT?
Autologous stem cell transplant (ASCT) refers to a medical procedure in which a person’s own stem cells are collected and then reintroduced into their body after high-dose chemotherapy or radiation therapy. This type of transplant is commonly used in the treatment of certain cancers, such as multiple myeloma, lymphoma, and leukemia.
I am a long-term survivor of multiple myeloma. I had an ASCT in December of 1995. I reached partial remission after my ASCT and relapsed about a year later. I developed chemotherapy-induced cardiomyopathy and atrial fibrillation in December of 2010. No, my extensive chemotherapy and ASCT is not the reason why I am able to write this post.
If you are considering an ASCT, please consider undergoing health healthy nutrition, supplementation and lifestyle therapies before, during and after your procedure.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
“Clonal hematopoiesis of indeterminate potential (CHIP) is the presence of a clonally expanded hematopoietic stem cell caused by a leukemogenic mutation in individuals without evidence of hematologic malignancy, dysplasia, or cytopenia. CHIP is associated with a 0.5-1.0% risk per year of leukemia…”
“Results Of 1036 consecutive patients with MM who underwent a first autologous HCT, 201 patients had at least 1 CHIP variant (19.4%) and 35 patients had 2 or more variants (3.4%).
The 5-year incidence of CVD was significantly higher in patients with CHIP (21.1% vs 8.4%; P < .001) compared with those without CHIP; the 5-year incidence among those with 2 or more variants was 25.6%.
In the multivariable model, CHIP was associated with increased risk of CVD , as well as of individual outcomes of interest, including
- heart failure,
- coronary artery disease, and
- stroke.
Patients who had both CHIP and preexisting hypertension or dyslipidemia were at nearly 7-fold and 4-fold increased risk of CVD, respectively (reference: no CHIP, no hypertension, or dyslipidemia).
Conclusion and Relevance CHIP was significantly and independently associated with risk of CVD in patients with MM undergoing HCT and may serve as a novel biologically plausible biomarker for CVD in this cohort. Patients with MM and both CHIP and cardiovascular risk factors had an exceptionally high risk of CVD. Additional studies are warranted to determine if cardiovascular preventive measures can reduce CHIP-associated CVD risk…
In this study, leveraging a large, well-characterized, and demographically diverse cohort of patients with MM undergoing autologous HCT with available pre-HCT DNA, we found that CHIP was highly prevalent and associated with a significantly higher incidence of CVD after HCT compared with those without CHIP.
In the adjusted model, CHIP was associated with a nearly 3-fold risk of developing any CVD and this association remained consistent by CVD subtype. The incidence of CVD after HCT was highest in patients with CHIP and hypertension or dyslipidemia (30% each), corresponding to nearly 7-fold and 4-fold increased risk of CVD, respectively, compared with those without CHIP and these modifiable risk factors…
The presence of CHIP prior to HCT was significantly and independently associated with increased risk of de novo heart failure, CAD, stroke, as well as composite CVD…
