title: Chronic neutrophilic leukemia: novel mutations and their impact on clinical practice.
abstract: OBJECTIVE
  Chronic neutrophilic leukemia (CNL) is a rare BCR-ABL1-negative myeloid malignancy that is characterized by mature granulocytosis without dysgranulopoiesis. Differential diagnosis of CNL includes reactive or secondary granulocytosis and other myeloid neoplasms, such as atypical chronic myeloid leukemia (aCML) and chronic myelomonocytic leukemia (CMML). Herein, we focus on recently described mutations in CNL and their impact on diagnosis, prognosis and treatment.
  
  
  RESULTS
  In 2013, membrane-proximal CSF3R mutations, most frequently CSF3RT618I, were described in CNL and aCML. Subsequent studies confirmed the presence of such mutations in nearly all patients with CNL but not in aCML. Furthermore, the majority of the patients with CSF3R-mutated CNL also expressed other mutations, such as SETBP1 and ASXL1, which might be prognostically detrimental. Laboratory studies revealed that CSF3RT618I induced JAK inhibitor-sensitive activation of JAK-STAT and CNL-like disease in mice. Case reports have indicated palliative but not disease-modifying activity of JAK inhibitor therapy in CSF3R-mutated CNL.
  
  
  CONCLUSIONS
  CNL is now a morphologically and molecularly defined myeloid malignancy, and no longer a diagnosis of exclusion. The identification of CNL-specific molecular markers provides a much needed pathogenetic insight and also offers the opportunity to revise current diagnostic criteria and identify prognostic biomarkers and potential drug targets.
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
authors.forename: Michelle
authors.initials: M
authors.lastname: Elliott
authors.forename: Animesh
authors.initials: A
authors.lastname: Pardanani
mesh_terms: D019468:Disease Management; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000235:genetics; D015467:Leukemia, Neutrophilic, Chronic / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D009154:Mutation; D009503:Neutropenia / Q000151:congenital / Q000235:genetics; D011379:Prognosis; D016184:Receptors, Colony-Stimulating Factor / Q000235:genetics
chemical_list: C517047:CSF3R protein, human; D016184:Receptors, Colony-Stimulating Factor