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Designation of activating <jats:italic>CSF3R<\/jats:italic> 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. <jats:italic>CSF3R<\/jats:italic> 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\u2009years, none of whom have transformed to acute leukemia. A heterozygous T618I <jats:italic>CSF3R<\/jats:italic> 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\u2010dependent manner. Collectively, these data provide additional insights into the natural history of familial CNL arising from T618I <jats:italic>CSF3R<\/jats:italic> mutations and suggest that enhanced neutrophil survival also contributes to the high neutrophil count observed in patients with CNL.<\/jats:p>","DOI":"10.1002\/ajh.27420","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T07:41:18Z","timestamp":1719474078000},"page":"1877-1886","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Hereditary chronic neutrophilic leukemia in a four\u2010generation family without transformation to acute leukemia"],"prefix":"10.1002","volume":"99","author":[{"given":"Amanda","family":"Lance","sequence":"first","affiliation":[{"name":"Hematology Oncology Translational Research Laboratory Levine Cancer Institute, Atrium Health  Charlotte North Carolina 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