Clonal hematopoiesis in Gulf War Veterans

Abstract:Veterans of the 1990–1991 Gulf War (GW) endured exposures from oil well fire smoke, pesticides, burn pits, depleted uranium, jet fuel, chemical warfare, and nerve agents. The National Academies of Science, Engineering, and Medicine have reported sufficient data to associate GW deployment with chronic multisystem illness and post-traumatic stress disorder, but owing to latency there are insufficient data to associate GW deployment with hematologic malignancies. Given the difficulty attributing adverse health outcomes to wartime exposures, the Veterans Health Administration (VHA) expanded healthcare to veterans with presumptive conditions following burn pit exposure, and myeloid neoplasms (MN) were recently added as a presumptive condition. Clonal hematopoiesis (CH) is a precursor to MN and may be an indicator of clinically significant toxin exposure. Exposures to chemotherapy, cigarette smoke, and ionizing radiotherapy are known to heighten the risk of CH of indeterminate potential (CHIP), and data suggest that toxic exposures to World Trade Center particulate matter after 9/11 can also increase CHIP. Therefore, there is rationale that GW exposures could also increase the risk of CH. Unlike Agent Orange-exposed Vietnam veterans and atomic veterans who have already declared their long-term comorbidities, GW veterans are at an age that CH could be detected but clinical comorbidities including MN may not have begun to manifest.