Clonal haematopoiesis in chronic lymphocytic leukaemia: Biology, inflammaging and clinical implications in the era of targeted therapy

Clonal haematopoiesis (CH) is common in patients with chronic lymphocytic leukaemia (CLL) and reflects age-related genomic and inflammatory remodeling of haematopoiesis. CH may influence prognosis, treatment-related toxicities, cardiovascular risk, and the development of therapy-related myeloid neoplasms. Targeted therapies, including BTK and BCL2 inhibitors, interact differently with CH compared with chemoimmunotherapy, potentially mitigating some adverse effects. Integrating CH assessment into CLL management may improve risk stratification and long-term survivorship strategies.