An interesting article was published in the Journal Nature Communications a few weeks ago, authored by a team from Dana Farber Cancer Institute, reminding us of something that we tend to not hear about in our travels: the relationship between multiple myeloma and CHIP. But what is this CHIP? CHIP stands for Clonal Hematopoeisis of Indeterminate Potential, and is very nicely explained in information provided on the Dana Farber website (and I highly recommend you read the full blog post on the link just provided):
‘As people age, it is normal for their blood-forming cells, known as hematopoietic stem cells (HSCs), to acquire genetic mutations, or misspellings, in their DNA. Most of these mutations do not affect how HSCs function or cause disease. In some cases, however, the mutations give certain HSCs an edge in survival, granting them an outsized role in producing blood cells. When this situation arises in people who are otherwise healthy, it’s known as clonal hematopoiesis of indeterminate potential (CHIP). [Note : the ‘edge in survival’ just mentioned does not refer to the survival of the patient but survival of these potentially harmful cells.]
Individuals with CHIP do not have symptoms of disease or markedly abnormal blood counts, but their risk of developing a blood cancer such as leukemia is 10 times higher than average, Dana-Farber researchers have found. That translates into a 1 percent chance per year of developing one of these diseases. People with CHIP also have an increased risk of cardiovascular disease and of leukemia resulting from treatment for other cancers.’
The article builds on the prior understanding of the negative impact CHIP may have on multiple myeloma patients who are or will be undergoing Stem Cell Transplants (SCT). The Dana Farber team studied the prevalence of 224 mutated genes that tend to be present in the blood of those with hematological malignancies. This was done by sequencing the DNA of purified stem cell product, harvested before transplant, from 629 transplant patients treated over an 8-year period.
Here are some of the reported conclusions :
And I am already hearing some say, ‘Well, that does it for me ! I am going to take myself off maintenance with [Revlimid, Pomalyst, Thalomid] ! And save me a bundle in the process !’ Before you do so, however, you need to be aware of a few other conclusions of this study :
In other words : If you have had a stem cell transplant, it is wise to stay on your IMiD’s maintenance, unless your physician tells you otherwise for this or that medical reason.
The bottom-line conclusion at the end of the Dana Farber study is plain and simple:
‘Altogether, these data suggest that the presence of CHIP at time of transplant does not increase the risk of TMN (secondary cancers) associated with IMiD maintenance and that patients with CHIP, when treated with IMiD maintenance, obtain a survival benefit similar to that seen in multiple myeloma patients generally.’ … ‘ In fact, IMiD maintenance was not only associated with an improvement in both PFS and OS but it completely abrogated the deleterious effects of CHIP in the post-ASCT setting.’
And there you have it : some of us have CHIP, others do not. Your chance to have CHIP increases with increasing age. You may wish to talk to your physician if you have not yet been tested for CHIP, get tested and find out the result. If you have CHIP and you are not yet refractory to IMiD’s, you may wish to make sure to continue life with maintenance Revlimid (or one of the other immunomodulators).
about the author
Paul Kleutghen
I am a patient diagnosed in 2014 with primary plasma cell leukemia (pPCL), a rare and aggressive variant of multiple myeloma and have been very fortunate to find successful treatment at the division of Cellular Therapy at the Duke University Cancer Institute. My wife, Vicki, and I have two adult children and two grandsons who are the ‘lights of our lives’. Successful treatment has allowed Vicki and I to do what we love best : traveling the world, albeit it with some extra precautions to keep infections away. My career in the pharmaceutical industry has given me insights that I am currently putting to use as an advocate to lower drug pricing, especially prices for anti-cancer drugs. I am a firm believer that staying mentally active, physically fit, compliant to our treatment regimen and taking an active interest in our disease are keys to successful treatment outcomes.
Subscribe to the weekly "HealthTree Community for Myeloma Newsletter" for Myeloma news, life with Myeloma stories, Myeloma clinical trials, Myeloma 101 articles and events with Myeloma experts.