Recent advances in understanding clonal haematopoiesis in aplastic anaemia

SummaryAcquired aplastic anaemia (AA) is an immune‐mediated bone marrow failure disorder inextricably linked to clonal haematopoiesis. The majority ofAApatients have somatic mutations and/or structural chromosomal abnormalities detected as early as at diagnosis. In contrast to other conditions linked to clonal haematopoiesis, the clonal signature ofAAreflects its immune pathophysiology. The most common alterations are clonal expansions of cells lacking glycophosphotidylinositol‐anchored proteins, loss of human leucocyte antigen alleles, and mutations inBCOR/BCORL1,ASXL1andDNMT3A. Here, we present the current knowledge of clonal haematopoiesis inAAas it relates to aging, inherited bone marrow failure, and the grey‐zone overlap ofAAand myelodysplastic syndrome (MDS). We conclude by discussing the significance of clonal haematopoiesis both for improved diagnosis ofAA, as well as for a more precise, personalized approach to prognostication of outcomes and therapy choices.