Age-related clonal hematopoiesis associated with adverse outcomes

Siddhartha Jaiswal, Pierre Fontanillas, Jason Flannick, Alisa Manning, Peter V. Grauman, Brenton G. Mar, R. Coleman Lindsley, Craig H. Mermel, Noel Burtt, Alejandro Chavez, John M. Higgins, Vladislav Moltchanov, Frank C. Kuo, Michael J. Kluk, Brian Henderson, Leena Kinnunen, Heikki A. Koistinen, Claes Ladenvall, Gad Getz, Adolfo CorreaBenjamin F. Banahan, Stacey Gabriel, Sekar Kathiresan, Heather M. Stringham, Mark I. McCarthy, Michael Boehnke, Jaakko Tuomilehto, Christopher Haiman, Leif Groop, Gil Atzmon, James G. Wilson, Donna Neuberg, David Altshuler, Benjamin L. Ebert

Research output: Contribution to journalArticlepeer-review


Background The incidence of hematologic cancers increases with age. These cancers are associated with recurrent somatic mutations in specific genes. We hypothesized that such mutations would be detectable in the blood of some persons who are not known to have hematologic disorders.

METHODS We analyzed whole-exome sequencing data from DNA in the peripheral-blood cells of 17, 182 persons who were unselected for hematologic phenotypes. We looked for somatic mutations by identifying previously characterized single-nucleotide variants and small insertions or deletions in 160 genes that are recurrently mutated in hematologic cancers. The presence of mutations was analyzed for an association with hematologic phenotypes, survival, and cardiovascular events.

RESULTS Detectable somatic mutations were rare in persons younger than 40 years of age but rose appreciably in frequency with age. Among persons 70 to 79 years of age, 80 to 89 years of age, and 90 to 108 years of age, these clonal mutations were observed in 9.5% (219 of 2300 persons), 11.7% (37 of 317), and 18.4% (19 of 103), respectively. The majority of the variants occurred in three genes: DNMT3A, TET2, and ASXL1. The presence of a somatic mutation was associated with an increase in the risk of hematologic cancer (hazard ratio, 11.1; 95% confidence interval [CI], 3.9 to 32.6), an increase in all-cause mortality (hazard ratio, 1.4; 95% CI, 1.1 to 1.8), and increases in the risks of incident coronary heart disease (hazard ratio, 2.0; 95% CI, 1.2 to 3.4) and ischemic stroke (hazard ratio, 2.6; 95% CI, 1.4 to 4.8).

CONCLUSIONS Age-related clonal hematopoiesis is a common condition that is associated with increases in the risk of hematologic cancer and in all-cause mortality, with the latter possibly due to an increased risk of cardiovascular disease.

Original languageEnglish
Pages (from-to)2488-2498
Number of pages11
JournalNew England Journal of Medicine
Issue number26
StatePublished - 25 Dec 2014
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2014 Massachusetts Medical Society. All rights reserved.

ASJC Scopus subject areas

  • General Medicine


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