1. Academic Validation
  2. Hereditary chronic neutrophilic leukemia in a four-generation family without transformation to acute leukemia

Hereditary chronic neutrophilic leukemia in a four-generation family without transformation to acute leukemia

  • Am J Hematol. 2024 Jun 27. doi: 10.1002/ajh.27420.
Amanda Lance 1 Zane Chiad 2 Sara L Seegers 1 Sarah-Catherine Paschall 1 Kendra Drummond 1 Nury M Steuerwald 3 Hsih-Te Yang 4 Jenny Chen 4 Peter M Voorhees 2 Belinda R Avalos 1 2 Lawrence J Druhan 1 2 5
Affiliations

Affiliations

  • 1 Hematology Oncology Translational Research Laboratory, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA.
  • 2 Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA.
  • 3 Molecular Biology Core Laboratory, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA.
  • 4 Department of Biostatistics and Data Sciences, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA.
  • 5 Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Abstract

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm (MPN) characterized by peripheral blood neutrophilia, marrow granulocyte hyperplasia, hepatosplenomegaly, and driver mutations in the colony-stimulating factor 3 receptor (CSF3R). Designation of activating CSF3R mutations as a defining genomic abnormality for CNL has led to increased recognition of the disease. However, the natural history of CNL remains poorly understood with most patients reported being of older age, lacking germline data, and having poor survival, in part due to transformation to acute leukemia. CSF3R driver mutations in most patients with CNL have been reported to be acquired, although rare cases of germline mutations have been described. Here, we report the largest pedigree to date with familial CNL, spanning four generations with affected family members ranging in age from 4 to 53 years, none of whom have transformed to acute leukemia. A heterozygous T618I CSF3R mutation was identified in peripheral blood and mesenchymal stromal cells from the proband and in all affected living family members, while the unaffected family members tested were homozygous wild type. We show that the T618I mutation also confers a survival advantage to neutrophils in an MCL1-dependent manner. Collectively, these data provide additional insights into the natural history of familial CNL arising from T618I CSF3R mutations and suggest that enhanced neutrophil survival also contributes to the high neutrophil count observed in patients with CNL.

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