Real-world experience of cancer patients with clonal hematopoiesis in an urban county hospital system.

Abstract

e18630 Background: Clonal hematopoiesis (CH), including CH of indeterminate potential (CHIP) and clonal cytopenia of undetermined significance (CCUS), is associated with increased comorbidities and risk of myeloid transformation. Most CH studies focus on predominantly white, healthy populations. Outcomes in cancer patients (pts), particularly those treated in safety-net settings, remain poorly defined. We evaluated clinical characteristics of cancer pts with CH in an underserved county hospital. Methods: We retrospectively identified oncology pts with CH detected by next-generation sequencing (NGS) panel xF+ (Tempus AI, Chicago, IL) at a county hospital from November 2024 to October 2025. Pt characteristics at CH detection were assessed and compared with those of cancer pts with CH from a tertiary cancer hospital. Survival was updated in December 2025. Results: Out of 256 pts with xF+ data, 40 pts (16%) had CH (CHIP n=19 [48%], CCUS n=21 [52%]). Median age was 61 years (range: 24, 85); 23 were female (58%). Race was predominantly white (n=35, 88%) and ethnicity Hispanic (n=29, 73%). Median state Area Deprivation Index (ADI) was 6 (range: 1, 10), national ADI 65 (range: 2, 93), and Rural-Urban Commuting Area code 1 (range: 1, 9). The most common primary tumors were colorectal (n=8, 20%), lung (n=6, 15%), and cervical (n=4, 10%). Median Adult Comorbidity Evaluation (ACE)-27 score was 3 (range: 2, 3), with cardiovascular disease most prevalent (n=27, 68%). Median absolute neutrophil count (ANC) was 4.7 (range: 2.0, 18.8), hemoglobin 11.9 (range: 7.0, 14.8), platelet count 271 (range: 108, 696), and mean corpuscular volume (MCV) 90 (range: 67, 100). The most common mutations were TP53 (n=11, 27.5%), DNMT3A (n=11, 27.5%), and PPM1D (n=8, 20%); 3 (8%) pts had >1 CH mutation. By CH Risk Score (CHRS), 4 (10%), 17 (43%), and 19 (47%) pts were low, intermediate, and high risk, respectively. With median follow-up time 5.06 months (95% confidence interval [CI]: 4.37, 6.31), no pts developed myeloid malignancy, and median overall survival was not reached. Seven pts (18%) died, all from complications of their primary cancer. Compared with 59 tertiary-center cancer pts with CH, county hospital pts were younger (p=0.001), more often Hispanic (p<0.001), more socioeconomically disadvantaged (p=0.007), and from more metropolitan areas (p=0.048). They had higher ACE-27 scores (p<0.001), higher ANC (p=0.003) and platelet count (p<0.001), and lower MCV (p=0.005) and trended toward higher CHRS scores (12.0 vs 11.0, p=0.054). The cohorts underwent different NGS panels, and cancer center pts had a longer median follow-up time of 24.02 months (95% CI: 18.86, 34.04). Conclusions: Cancer pts with CH in an underserved county hospital had higher comorbidity burdens and CHRS scores than that of a traditional CH pt cohort. Longer follow-up time is needed to define transformation and survival outcomes in this pt population.