蒽环类化疗药物的主要剂量限制毒性是心脏毒性。无血液恶性肿瘤患者的造血干细胞或祖细胞的克隆性造血增多（CH），也与不良心血管事件的风险和整体预后恶化相关。我们假设CH增加奥氨葡萄糖诱导心脏毒性的风险（DIC）。我们在接受癌症奥氨葡萄糖治疗的患者中进行了回顾性队列研究（N = 100）。25名患者发生了心力衰竭、左室射血分数下降或心律失常的新发症状。通过使用成对的外周血和肿瘤DNA来确定CH。在调整了奥氨葡萄糖开始治疗的年龄、糖尿病、血脂异常和胸部放射线照射后，高累积剂量的奥氨葡萄糖（>240 mg/m2；比值比[OR]，7.00；95% CI，1.77至27.74；P = .0056），CH（OR，8.58；95% CI，2.05至35.99；P = .0033）和吸烟史（OR，3.15；95% CI，1.00至9.93；P = .0495）与DIC相关。本研究为CH作为DIC的预测性风险因素提供了初步证据，进一步研究后，可作为大量患有癌症且存在CH的患者的重要精准医学生物标志物。

The main dose-limiting toxicity of anthracyclines is cardiotoxicity. Clonal hematopoiesis (CH), somatic mutations in hematopoietic stem or progenitor cells in patients without hematologic malignancy, is also associated with risk for adverse cardiovascular events and worse outcomes overall. We hypothesize that CH increases risk for doxorubicin-induced cardiotoxicity (DIC).We conducted a retrospective cohort study in patients treated with doxorubicin for cancer (N = 100). Patients (n = 25) had incident symptomatic heart failure, decline in left ventricular ejection fraction, or arrhythmia. CH was identified using paired peripheral blood and tumor DNA.After adjusting for age at doxorubicin initiation, diabetes, dyslipidemia, and chest radiation, high cumulative dose of doxorubicin (>240 mg/m2; odds ratio [OR], 7.00; 95% CI, 1.77 to 27.74; P = .0056), CH (OR, 8.58; 95% CI, 2.05 to 35.99; P = .0033), and history of smoking (OR, 3.15; 95% CI, 1.00 to 9.93; P = .0495) were associated with DIC.This study provides preliminary evidence for CH as a predictive risk factor for DIC, which, with further investigation, could serve as an important precision medicine biomarker for the large number of patients with cancer who have CH.