ArticleCardio-oncology (London, England)2024
Clonal hematopoiesis of indeterminate potential is associated with increased risk of immune checkpoint inhibitor myocarditis in a prospective study of a cardio-oncology cohort.
Article in Cardio-oncology (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinical impact of clonal hematopoiesis on patients with solid tumors: a systematic review and meta-analysis.Frontiers in oncology · 2026Pooled it
- Clonal haematopoiesis and cardiovascular disease, defining risk, filling gaps, and framing the future.NPJ cardiovascular health · 2026Review
- Clonal hematopoiesis in patients with cancer and cancer survivors: From clonal burden to cardiovascular diseases.Cancer · 2026Review
- What's hidden in plain sight? Impact of clonal hematopoiesis on the risk and progression of nonhematologic cancers.Haematologica · 2026Review
- Advancing precision cardio-oncology: multimodal surveillance and stratified management of immunotherapy-induced cardiovascular toxicity.Frontiers in cardiovascular medicine · 2026Review
- Molecular basis of coronary artery disease-malignancy comorbidity: inflammation, immunometabolism, thrombosis, and cardio-oncology translation.Frontiers in immunology · 2026Review
- Clonal hematopoiesis of indeterminate potential and cancer immunotherapy: a host-intrinsic immune-inflammatory modifier of treatment efficacy and toxicity.Frontiers in oncology · 2026Review
- Omics-based biomarkers of immune-related organ toxicities associated with immune checkpoint inhibitors: a scoping review and evidence map.Frontiers in immunology · 2026Article
- Clonal Hematopoiesis Risk Score (CHRS) Evaluation as a Prognostic Marker for Death in Cardio-Oncology Cohort.JACC. Advances · 2025Article
- Clonal Hematopoiesis and Risk of New-Onset Myocarditis and Pericarditis.JAMA cardiology · 2025Observational
- Clonal hematopoiesis is associated with reduced response to atezolizumab in non-small cell lung cancer.Journal for immunotherapy of cancer · 2025Article
- Cancer-Related Immune Therapies: Bidirectional Implications From Cardiotoxicity to Emerging Cardiovascular Therapeutics: JACC CardioOncology State-of-the-Art Review.JACC. CardioOncology · 2025Review
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18 authors.
Funding
Abstract
backgroundClonal hematopoiesis of indeterminate potential (CHIP) has been shown to increase all-cause mortality and risk of cardiomyopathy in patients with solid malignancies. CHIP has also been shown to increase T cell activation in heart failure patients. It is unclear whether CHIP can affect the risk of immune checkpoint inhibitor (ICI) myocarditis in patients with cancer treated with immunotherapy.
methodsWe enrolled patients with solid tumors in a prospective study, determined CHIP status at time of enrollment through blood whole exome sequencing, and assessed incidence of ICI myocarditis from time of enrollment through December 1st, 2023. We performed a competing risk cox regression to evaluate the role of CHIP in ICI myocarditis, accounting for patient demographics, cardiac comorbidities, cardiotoxic cancer therapy, and dual ICI use in our covariates. We also generated cumulative incidence curves using subdistribution hazards to evaluate development of ICI myocarditis stratified by CHIP vs no CHIP. Chart review was performed to evaluate patient co-morbidities, lab values, imaging findings and outcomes.
resultsAmong the 88 patients receiving ICI therapy, average age was 67 ± 14 years, of which 50% harbored CHIP variants. Among all comorbidities, including diabetes, heart failure and obstructive coronary artery disease, only coronary artery calcifications were significantly increased in patients with CHIP. There were no statistically significant differences in cancer therapy or cardiovascular drugs between patients with and without CHIP. Among examined outcomes, patients with CHIP had a statistically higher rate of ICI myocarditis (overall: 57%, CHIP: 73% (32/44), no CHIP: 41% (18/44), p = 0.003) and death (CHIP: 60%, no CHIP 31%, p = 0.011). In a multivariate competing risk analysis, CHIP status doubled the risk of developing ICI myocarditis, similar to the risk of dual ICI use (CHIP status HR 2.74, 95% CI: 1.44-5.22, p = 0.002 vs dual ICI use HR 2.39, 95% CI: 1.11-5.14, p = 0.026).
conclusionsThis study is the first to show that CHIP independently increases risk of ICI myocarditis, with implications for risk stratification of patients prior to ICI initiation and frequency of cardiac monitoring.
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