Although there is no clear definition for high-risk CH, the presence of significant blood count abnormalities, a single CH mutation at a high VAF (> 10%), multiple CH mutations, variants in TP53 and PPM1D, DNMT3A variants, and hotspot mutations of IDH1/2 are considered to put patients in the high-risk group [2, 30]. Here, PPM1D is linked to cyclic hematopoiesis.