Radioactive iodine-related clonal hematopoiesis in thyroid cancer is common and associated with decreased survival Journal Article


Authors: Boucai, L.; Falcone, J.; Ukena, J.; Coombs, C. C.; Zehir, A.; Ptashkin, R.; Berger, M. F.; Levine, R. L.; Fagin, J. A.
Article Title: Radioactive iodine-related clonal hematopoiesis in thyroid cancer is common and associated with decreased survival
Abstract: Context: Radioactive iodine (RAI) has been epidemiologically associated with the development of hematologic malignancies. Clonal hematopoiesis (CH) is a precursor clonal state that confers increased risk of leukemia and occurs at an elevated rate in patients with thyroid cancer relative to other solid tumors. Objective: We explore if the high prevalence of CH may be a result of RAI exposure and whether CH may be a surrogate in the association between RAI and leukemia. Design: CH, CH-potential driver (CH-PD), and overall survival were evaluated in 279 patients with advanced thyroid carcinoma. Results: The prevalence of CH in patients with thyroid cancer was 37%, and that of CH-PD was 5.2%. Age was the strongest predictor of CH and CH-PD. For every year increase in age, there was a 5% and 13% increase in the odds of CH and CH-PD, respectively. RAI dose was significantly associated with CH and CH-PD, even after adjustment for age, external beam radiation therapy, and chemotherapy. For every 10 mCi increase in the dose of RAI administered, there was a 2% and 4% increase in the odds of CH and CH-PD, respectively. Patients with CH-PD previously exposed to RAI had a significantly poorer survival, even when stratified by age (heart rate = 3.75, 95% CI = 1.23 to 11.5, P = 0.02). Conclusions: RAI was associated with a high prevalence of CH, and CH is a precursor state of hematologic malignancies. The implications of this study may favor identification of CH in patients where the risks might outweigh the benefits of receiving RAI therapy for thyroid cancer.
Journal Title: Journal of Clinical Endocrinology and Metabolism
Volume: 103
Issue: 11
ISSN: 0021-972X
Publisher: Oxford University Press  
Date Published: 2018-11-01
Start Page: 4216
End Page: 4223
Language: English
DOI: 10.1210/jc.2018-00803
PUBMED: 30137527
PROVIDER: scopus
PMCID: PMC6194804
DOI/URL:
Notes: Article -- Export Date: 1 November 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. James A Fagin
    105 Fagin
  2. Ross Levine
    463 Levine
  3. Ahmet Zehir
    145 Zehir
  4. Michael Forman Berger
    373 Berger
  5. Laura   Boucai
    12 Boucai
  6. Jenny K Ukena
    1 Ukena