Genomics of chronic neutrophilic leukemia

Blood. 2017 Feb 9;129(6):715-722. doi: 10.1182/blood-2016-10-695981. Epub 2016 Dec 27.


Chronic neutrophilic leukemia (CNL) is a distinct myeloproliferative neoplasm with a high prevalence (>80%) of mutations in the colony-stimulating factor 3 receptor (CSF3R). These mutations activate the receptor, leading to the proliferation of neutrophils that are a hallmark of CNL. Recently, the World Health Organization guidelines have been updated to include CSF3R mutations as part of the diagnostic criteria for CNL. Because of the high prevalence of CSF3R mutations in CNL, it is tempting to think of this disease as being solely driven by this genetic lesion. However, recent additional genomic characterization demonstrates that CNL has much in common with other chronic myeloid malignancies at the genetic level, such as the clinically related diagnosis atypical chronic myeloid leukemia. These commonalities include mutations in SETBP1, spliceosome proteins (SRSF2, U2AF1), and epigenetic modifiers (TET2, ASXL1). Some of these same mutations also have been characterized as frequent events in clonal hematopoiesis of indeterminate potential, suggesting a more complex disease evolution than was previously understood and raising the possibility that an age-related clonal process of preleukemic cells could precede the development of CNL. The order of acquisition of CSF3R mutations relative to mutations in SETBP1, epigenetic modifiers, or the spliceosome has been determined only in isolated case reports; thus, further work is needed to understand the impact of mutation chronology on the clonal evolution and progression of CNL. Understanding the complete landscape and chronology of genomic events in CNL will help in the development of improved therapeutic strategies for this patient population.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Carrier Proteins / genetics
  • Carrier Proteins / metabolism
  • Cell Proliferation / drug effects
  • Clonal Evolution
  • DNA-Binding Proteins / genetics
  • DNA-Binding Proteins / metabolism
  • Dioxygenases
  • Disease Progression
  • Gene Expression Regulation, Leukemic / drug effects*
  • Genomics*
  • Humans
  • Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / drug therapy
  • Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / genetics*
  • Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / metabolism
  • Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / pathology
  • Leukemia, Neutrophilic, Chronic / drug therapy
  • Leukemia, Neutrophilic, Chronic / genetics*
  • Leukemia, Neutrophilic, Chronic / metabolism
  • Leukemia, Neutrophilic, Chronic / pathology
  • Mutation
  • Neutrophils / drug effects
  • Neutrophils / metabolism*
  • Neutrophils / pathology
  • Nuclear Proteins / genetics
  • Nuclear Proteins / metabolism
  • Practice Guidelines as Topic
  • Proto-Oncogene Proteins / genetics
  • Proto-Oncogene Proteins / metabolism
  • Receptors, Colony-Stimulating Factor / genetics
  • Receptors, Colony-Stimulating Factor / metabolism
  • Repressor Proteins / genetics
  • Repressor Proteins / metabolism
  • Serine-Arginine Splicing Factors / genetics
  • Serine-Arginine Splicing Factors / metabolism
  • Splicing Factor U2AF / genetics
  • Splicing Factor U2AF / metabolism


  • ASXL1 protein, human
  • Antineoplastic Agents
  • CSF3R protein, human
  • Carrier Proteins
  • DNA-Binding Proteins
  • Nuclear Proteins
  • Proto-Oncogene Proteins
  • Receptors, Colony-Stimulating Factor
  • Repressor Proteins
  • SETBP1 protein, human
  • Splicing Factor U2AF
  • U2AF1 protein, human
  • SRSF2 protein, human
  • Serine-Arginine Splicing Factors
  • Dioxygenases
  • TET2 protein, human