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Blood, 1 January 2007, Vol. 109, No. 1, pp. 93-99.
Prepublished online as a Blood First Edition Paper on September 19, 2006; DOI 10.1182/blood-2006-02-004275.
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Submitted February 17, 2006
Accepted August 9, 2006
Incidence of CSF3R mutations in severe congenital neutropenia and relevance for leukemogenesis - results of a long-term survey
Manuela Germeshausen*, Matthias Ballmaier, and Karl Welte
Deptartment of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
* Corresponding author; email: germeshausen.manuela{at}mh-hannover.de.
Point mutations in the gene for the G-CSF receptor CSF3R have been implicated in the progression of severe congenital neutropenia (CN) to leukemia. In this study we present data on a total of 218 patients with chronic neutropenia, including 148 patients with CN (23/148 with secondary malignancies). We detected CSF3R nonsense mutations at 17 different nucleotide positions (thereof 10 new mutations) which lead to a loss of one to all 4 tyrosine residues in the intracellular domain of the receptor. 18 out of 23 CN (78%) patients with signs of malignant transformation were shown to harbor a CSF3R mutation, indicating that these mutations, although not a necessary condition, are highly predictive for malignant transformation even if detected in a low percentage of transcripts. In serial analyses of 50 patients with CSF3R mutations we were able to follow the clonal dynamics of mutated cells. We could demonstrate that even a highly clonal hematopoiesis did not inevitably show a rapid progression to leukemia. Our results strongly suggest that acquisition of a CSF3R mutation is an early event in leukemogenesis which has to be accompanied by cooperating molecular events which remain to be defined.

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