{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T20:50:23Z","timestamp":1789159823133,"version":"build-2803163510"},"reference-count":57,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HemaSphere"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Whether clonal hematopoiesis (CH) in follicular lymphoma (FL) patients affects clinical outcome or is merely a bystander phenomenon is unclear. We leveraged the Phase III Fondazione Italiana Linfomi FOLL12 trial, which treated patients with advanced\u2010stage FL with R\u2010CHOP or R\u2010Bendamustine, to evaluate the role of myeloid CH at baseline and after chemoimmunotherapy (CIT). A total of 528 serial blood samples from 242 FL were analyzed by CAPP\u2010Seq. At baseline, CH occurred in 35.5% patients with\n                    <jats:italic>DNMT3A<\/jats:italic>\n                    (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200941, 16.9%) and\n                    <jats:italic>TET2<\/jats:italic>\n                    (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200929, 12.0%) being the most frequently mutated genes. After a median follow\u2010up of 8.2 years, CH at baseline did not impact progression\u2010free survival (PFS), overall survival (OS), or risk of transformation (P\u2009=\u20090.660, P\u2009=\u20090.230, and P\u2009=\u20090.584, respectively), but instead associated with therapy\u2010related hematological toxicities driven by\n                    <jats:italic>TET2<\/jats:italic>\n                    mutations. CH dynamics after the genotoxic pressure imposed by CIT was evaluated in 211 patients provided with sequential samples. CIT significantly expanded both prevalence and size of CH, with clones affected by DNA damage response (DDR) gene mutations exhibiting the highest fitness. Distinct selective pressures were observed between R\u2010CHOP and R\u2010Bendamustine, with the latter creating a tighter bottleneck that facilitates the emergence of fitter CH clones preferentially carrying\n                    <jats:italic>TP53<\/jats:italic>\n                    mutations. Patients acquiring fit DDR clones (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200937) had inferior long\u2010term outcomes, including independent increased risk of second malignancies (hazard ratio [HR] 2.63, P\u2009=\u20090.035) that developed in 28 patients, and shorter OS (HR 3.28, P\u2009=\u20090.008). CH emerges as a novel and potentially valuable biomarker in FL, capable of predicting long\u2010term toxicities that are key endpoints in indolent lymphoid malignancies characterized by long\u2010lasting survival.\n                  <\/jats:p>","DOI":"10.1002\/hem3.70393","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T12:55:07Z","timestamp":1779281707000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clonal hematopoiesis dynamics influences long\u2010term outcomes of follicular lymphoma: Results from FIL FOLL12 trial"],"prefix":"10.1002","volume":"10","author":[{"given":"Nawar","family":"Maher","sequence":"first","affiliation":[{"name":"Division of Hematology, Department of Translational Medicine Universit\u00e0 del Piemonte Orientale and AOU Maggiore della Carit\u00e0 di Novara Novara Italy"},{"name":"Department of Translational Medicine, SCDU Ematologia AO SS Antonio e Biagio E Cesare Arrigo Universit\u00e0 del Piemonte Orientale Alessandria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7393-1138","authenticated-orcid":false,"given":"Riccardo","family":"Moia","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Translational Medicine Universit\u00e0 del Piemonte Orientale and AOU Maggiore della Carit\u00e0 di Novara Novara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Almasri","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Translational Medicine Universit\u00e0 del Piemonte Orientale and AOU Maggiore della Carit\u00e0 di Novara Novara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Cividini","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Translational Medicine Universit\u00e0 del Piemonte Orientale and AOU Maggiore della Carit\u00e0 di Novara Novara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Genuardi","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Molecular Biotechnologies and Health Sciences University of Torino Torino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Cosentino","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Translational Medicine Universit\u00e0 del Piemonte Orientale and AOU Maggiore della Carit\u00e0 di Novara Novara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Soscia","sequence":"additional","affiliation":[{"name":"Hematology, Department of Translational and Precision Medicine Sapienza University of Rome \u2013 AOU Policlinico Umberto I Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6190-9635","authenticated-orcid":false,"given":"Giovanni Manfredi","family":"Assanto","sequence":"additional","affiliation":[{"name":"Hematology, Department of Translational and Precision Medicine Sapienza University of Rome \u2013 AOU Policlinico Umberto I Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Tavarozzi","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, SCDU Ematologia AO SS Antonio e Biagio E Cesare Arrigo Universit\u00e0 del Piemonte Orientale Alessandria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carmela","family":"Vegliante","sequence":"additional","affiliation":[{"name":"Hematology and Cell Therapy Unit IRCCS Istituto Tumori 'Giovanni Paolo II Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Lorenzi","sequence":"additional","affiliation":[{"name":"Pathology Unit, Department of Molecular and Translational Medicine University of Brescia Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Andorno","sequence":"additional","affiliation":[{"name":"Division of Pathology, Department of Health Sciences Universit\u00e0 del Piemonte Orientale and Ospedale Maggiore della Carit\u00e0 Novara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9504-991X","authenticated-orcid":false,"given":"Luca","family":"Arcaini","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine University of Pavia &amp; 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