About 1 in 5 patients with cancer who undergo genetic testing are incidentally found to have mutations in their blood called clonal hematopoiesis of indeterminate potential (CHIP). A study from Vanderbilt Health researchers reveals that it puts them at increased risk for heart disease following cancer treatment.

The findings, published Jan. 8 in JAMA Oncology, support the potential benefits of screening patients for CHIP before they undergo cancer treatment so they can be more closely monitored for heart complications. CHIP is a condition, not a disease, characterized by age-related variants in blood stem cells, and it is typically asymptomatic.

The researchers were able to determine which patients had CHIP by using Vanderbilt Health’s biorepository, BioVU, to link electronic health records with whole-genome sequencing data. They compared the cardiovascular health outcomes of the patients with CHIP to outcomes of patients without the condition. All the patients had been diagnosed with solid tumors, and none had heart failure, ischemic heart disease or arrhythmia before undergoing cancer treatment.

Over a 10-year period following treatment, patients with CHIP had a significantly higher incidence of heart failure (20.3% versus 14.5%) and ischemic cardiovascular disease (25.3% versus 18.5%). The effect was amplified in patients who received more intensive chemotherapy.

“We frequently find CHIP in patients with cancer, but previously we did not consider this to be an important result for their care. We now know that these patients are at higher risk of heart disease and would likely benefit from including cardiologists in their care team,” said the study’s corresponding author, Alexander Bick, MD, PhD, associate professor of Medicine, holder of the Edward Claiborne Stahlman Chair, and director of the Division of Genetic Medicine and Clinical Pharmacology.

The patients received chemotherapy, radiotherapy, immunotherapy, or a combination of the treatments. Cardiovascular disease is the leading cause of noncancer deaths among cancer survivors.

The researchers analyzed data from 8,004 patients, and 549 of them were identified with CHIP. To their knowledge, the study is the largest to date evaluating the association between CHIP and cardiovascular disease in patients with solid tumors who underwent cancer treatment. Most patients with CHIP were male (54% versus 45%) and had hypertension (78% versus 69%) compared to patients without the condition.

The clinical implications of the study are that there may be value in testing patients for CHIP prior to cancer treatment to stratify risk and tailor monitoring for cardiovascular diseases and offering early cardio-oncology consultations as well as consideration of cardioprotective strategies.  

The researchers received support from the National Institutes of Health (grants DP5OD029586 and T32GM007347). The sequencing of 250,000 individuals who have donated samples to BioVU has been funded by the Alliance for Genomic Discovery.

The study’s first authors are Derek Shyr, PhD, and Yash Pershad. The study was jointly supervised by Bick and Leo Luo, MD, assistant professor of Radiation Oncology at Vanderbilt Health.

Other Vanderbilt Health authors on the study are Ashwin Kishtagari, MD, Robert Corty, MD, PhD, Eric Shinohara, MD, MSCI, Ben Ho Park, MD, PhD, and Brett Heimlich, MD, PhD.

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A new prospective clinical trial with updated data on COVID-19 hospitalizations and deaths among patients with cancer confirms the importance of vaccination and sheds light on which conditions put patients most at risk. 

Patients who had been vaccinated had a 50% reduction in risk of hospitalization, according to data from the National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) published July 17 in JAMA Oncology.

Death incidence was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and lowest in patients with other solid tumors or with blood cancers other than lymphoma. Patients who had undergone chemotherapy or who had a history of stroke, atrial fibrillation and pulmonary embolism were at higher risk for hospitalization. 

The finding that patients with lymphoma had the highest risk of death suggests a potential detrimental effect of B-cell-depleting therapy on COVID-19 outcomes, the study stated, but the authors noted that this hypothesis was confounded by the inherent immunosuppression in patients with lymphoma. 

“These results are important because they represent the only prospective clinical trial in patients with a recent diagnosis of COVID and an active cancer undergoing therapy,” said the study’s lead author Brian Rini, MD, Ingram Professor of Cancer Research and Thomas F. Frist Sr. Professor of Medicine. 

Rini is one of two principal investigators of NCCAPS. The other is Lorissa Korde, MD, with NCI’s Cancer Therapy Evaluation Program, who is the study’s senior author. Patients were accrued for the study between 2020 and 2022, and the statistical analysis took place between September 2024 and April 2025. 

The study involved 1,572 adult patients who had a COVID-19 diagnosis within 14 days while receiving active treatment for cancer or had a prior stem cell transplant or CAR-T cellular treatment therapy. In addition to outcomes, investigators analyzed COVID-19 therapies patients received and disruptions in cancer treatment. The most common type of disruption was a delayed cancer treatment. 

The majority of patients had already been accrued for analysis before the Food and Drug Administration gave emergency use authorization for the antiviral treatment nirmatrelvir with ritonavir, which is most commonly known by its brand name, Paxlovid. Of the patients who enrolled in the study after the first COVID-19 vaccine received FDA emergency use authorization, 41.5% were fully vaccinated. 

“These data provide a road map to protect the most vulnerable cancer populations not only from COVID, but from potential future pandemics,” Rini said. 

Patients hospitalized for COVID-19 within 90 days of enrollment accounted for 18.4% of the study group. Among the hospitalized patients, 23.4% were admitted to an intensive care unit.  

The study was funded in part by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and also by the National Cancer Institute National Clinical Trials Network, Experimental Therapeutics Clinical Trials Network, and Community Oncology Research Program grants via the U10 funding mechanism.  

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