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Summary: Recursive partitioning of healthy consortia led to the development of the Clonal Hematopoiesis Risk Score (CHRS) for clonal haematopoiesis (CH); however, in the practical setting, most cases of CH are diagnosed after patients present with cytopenias or related symptoms. To address this real‐world population, we characterize the clinical trajectories of 94 patients with CH and distinguish CH harbouring canonical DNMT3A/TET2/ASXL1 mutations alone ('sole DTA') versus all other groups ('non‐sole DTA'). TET2, rather than DNMT3A, was the most prevalent mutation in the real‐world setting. Sole DTA patients did not progress to myeloid neoplasm (MN) in the absence of acquisition of other mutations. Contrastingly, 14 (20.1%) of 67 non‐sole DTA patients progressed to MN. CHRS assessment showed a higher frequency of high‐risk CH in non‐sole DTA (vs. sole DTA) patients and in progressors (vs. non‐progressors). RUNX1 mutation conferred the strongest risk for progression to MN (odds ratio [OR] 10.27, 95% CI 2.00–52.69, p = 0.0053). The mean variant allele frequency across all genes was higher in progressors than in non‐progressors (36.9% ± 4.62% vs. 24.1% ± 1.67%, p = 0.0064). This analysis in the post‐CHRS era underscores the natural history of CH, providing insight into patterns of progression to MN. [ABSTRACT FROM AUTHOR]

Summary: Cytomegalovirus (CMV) DNAemia and disease are common complications in patients undergoing allogeneic haematopoietic stem cell transplantation (allo‐HSCT). Few studies have compared the efficacy and safety of the HSCT donor and third‐party CMV‐specific cytotoxic T lymphocytes (CMV‐CTLs) in the treatment of CMV DNAemia and disease. In this study, we retrospectively compared the efficacy and safety of HSCT donor and third‐party CMV‐CTLs in patients with refractory CMV DNAemia or disease after allo‐HSCT at our centre from January 2017 to September 2021. Fifty‐three patients who received CMV‐CTL therapy were enrolled, including 40 in the donor group and 13 in the third‐party group, and they were adults aged 18 years or older. Within 6 weeks of treatment, 26 (65.0%) and 9 (69.2%) patients achieved complete response in the donor and third‐party groups (p = 1.000). The 2‐year overall survival was 59.6% (95% CI 46.1%–77.1%) and 53.8% (32.6%–89.1%) in the donor and third‐party groups (p = 0.860). Four (10.0%) patients in the donor group and two (15.4%) patients in the third‐party group developed acute graft‐versus‐host disease within 3 months after CMV‐CTL infusions. In conclusion, our data suggest that donor and third‐party CMV‐CTLs have comparable efficacy and safety for refractory CMV DNAemia and disease. [ABSTRACT FROM AUTHOR]