S E Langabeer1, K Haslam2, J Kelly3, J Quinn4, R Morrell5, E Conneally6. 1. Central Pathology Laboratory, Cancer Molecular Diagnostics, St. James's Hospital, Dublin 8, Ireland. slangabeer@stjames.ie. 2. Central Pathology Laboratory, Cancer Molecular Diagnostics, St. James's Hospital, Dublin 8, Ireland. 3. Department of Clinical Genetics, Our Lady's Children's Hospital, Dublin, Ireland. 4. Department of Haematology, Beaumont Hospital, Dublin, Ireland. 5. Department of Haematology, Letterkenny University Hospital, Letterkenny, Ireland. 6. Department of Haematology, St. James's Hospital, Dublin, Ireland.
Abstract
PURPOSE: Chronic neutrophilic leukemia is a rare form of myeloproliferative neoplasm characterized by mature neutrophil hyperleukocytosis. The majority of patients harbor somatic mutations of CSF3R gene and are potentially amenable to targeted therapy with JAK inhibitors. The incidence and clinical significance of additional mutations requires clarification. MATERIALS AND METHODS: A next-generation sequencing approach for myeloid malignancy-associated mutations was applied to diagnostic and matched blast crisis samples from four chronic neutrophilic leukemia patients. RESULTS: Next-generation sequencing confirmed the CSF3R T618I in all patients with identification of concurrent SRSF2, SETBP1, NRAS and CBL mutations at diagnosis. At blast crisis, clonal evolution was evidenced by an increased CSF3R T618I allele frequency and by loss or acquisition of CBL and NRAS mutations. CONCLUSION: The diagnostic utility of a targeted next-generation sequencing approach was clearly demonstrated with the identification of additional mutations providing the potential for therapeutic stratification of chronic neutrophilic leukemia patients.
PURPOSE:Chronic neutrophilic leukemia is a rare form of myeloproliferative neoplasm characterized by mature neutrophil hyperleukocytosis. The majority of patients harbor somatic mutations of CSF3R gene and are potentially amenable to targeted therapy with JAK inhibitors. The incidence and clinical significance of additional mutations requires clarification. MATERIALS AND METHODS: A next-generation sequencing approach for myeloid malignancy-associated mutations was applied to diagnostic and matched blast crisis samples from four chronic neutrophilic leukemiapatients. RESULTS: Next-generation sequencing confirmed the CSF3RT618I in all patients with identification of concurrent SRSF2, SETBP1, NRAS and CBL mutations at diagnosis. At blast crisis, clonal evolution was evidenced by an increased CSF3RT618I allele frequency and by loss or acquisition of CBL and NRAS mutations. CONCLUSION: The diagnostic utility of a targeted next-generation sequencing approach was clearly demonstrated with the identification of additional mutations providing the potential for therapeutic stratification of chronic neutrophilic leukemiapatients.
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