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The Center for Prevention of Progression cares for patients diagnosed with – or at high risk for – precursor conditions of hematologic malignancies, including:
Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related condition that occurs in 10 to 15 percent of people over age 65 and at least 30 percent by age 80. In clonal hematopoiesis, some blood-forming stem cells acquire mutations and contribute
more than their share to blood cell development. Individuals with CHIP don't have symptoms or obvious abnormalities in their blood counts, but Dana-Farber research has shown CHIP to be associated with a 10-fold increase in risk for all blood cancers,
and with an increased risk of therapy-related leukemia as well as cardiovascular disease. Another term used for CHIP is age-related clonal hematopoiesis (ARCH).
Sometimes patients with low blood counts undergo evaluation, including bone marrow and blood tests, but no specific cause is found for the low blood counts. These patients can be termed as having "idiopathic cytopenias of undetermined significance" (ICUS).
Some patients with ICUS will eventually develop a disease, but in most the counts will remain stable. In a proportion of patients, mutations similar to those seen in CHIP can be detected; this state is termed "clonal cytopenias of undetermined significance"
(CCUS). Patients with CCUS have a much higher risk of progression than patients with ICUS, including a 13-fold increased risk of developing blood cancer such as AML or MDS. At four years after detection of CCUS, 75 percent of patients will have MDS
or AML compared to <10 percent with ICUS.
MGUS is a condition in which there are abnormal plasma cells in the bone marrow, but there is no cancer. The abnormal plasma cells produce monoclonal (M) protein. In most patients, the amount of M protein stays the same, and there are no symptoms or problems.
In some patients, MGUS may later become a more serious condition or cancer, such as multiple myeloma, lymphoma, or Waldenström's macroglobulinemia. MGUS is three times more common in African-Americans.
Smoldering myeloma is a precursor condition in which high concentrations of abnormal plasma cells are found in the bone marrow and secrete monoclonal (M) proteins and/or free light-chains (FLCs). SMM is characterized by the absence of end organ damage;
M protein concentrations of 3 g/dL or greater; 10 percent or more abnormal plasma cells in the bone marrow; or a combination of all of these factors. Smoldering myeloma may progress to multiple myeloma.
Many patients with myelodysplastic syndromes have mild blood count abnormalities and do not require initial treatment, but are at risk for progression. Our understanding
of which patients are at high risk for progression is evolving and involves assessment of acquired gene mutations.
Monoclonal B-cell lymphocytosis (MBL) is very common in people older than 50 years and can be a precursor condition to chronic lymphocytic leukemia (CLL). Most
people who develop CLL have had MBL, and about 1 percent per year will convert to CLL. MBL also predisposes to non-Hodgkin lymphoma.
Center for Prevention of Progression Appointments