FEATURE
Whether CHIP should affect treatment, and how,
depends on the clinical context of the discovery.
For example, a study of patients with solid-tumor
malignancies undergoing chemotherapy who had CHIP at
the time of primary diagnosis were almost six times more
likely to later develop a therapy-related malignancy than
those without CHIP (odds ratio = 5.75; 95% CI 1.52-25.09;
p=0.013). 11 This finding could have important clinical im-
plications for treatment of patients who present with CHIP
at the time of primary cancer diagnosis, the study’s lead
author Nancy K. Gillis, PharmD, postdoctoral fellow at the
Moffitt Cancer Center in Florida, said.
“Our eventual goal is to incorporate this into decision
algorithms to help guide a treatment plan,” she explained,
offering the following example: “If you are trying to deter-
mine whether a patient should receive adjuvant therapy for
her breast cancer, and you know that she has CHIP, maybe
you would decide against giving additional chemotherapy
because the risk [of developing a second malignancy]
outweighs the benefit.” It would also need to be determined
whether it makes sense from a health policy perspective to
screen a large population of patients with solid tumors to
detect the relatively small number of patients destined to
develop a therapy-related myeloid neoplasm.
Dr. Levine recommends patients be evaluated for a
myeloid malignancy if they exhibit CHIP with high-risk
features (like high variant allele frequency or multiple
distinct mutations). In the absence of these risk factors,
clinicians should consider a “watch-and-wait” approach
with regular bloodwork. (For an in-depth look at CHIP,
see “Determining CHIP’s Potential” in our special edition,
“Focus on Myeloid Malignancies.”)
Continued on page 64