{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T21:30:54Z","timestamp":1775079054614,"version":"3.50.1"},"reference-count":23,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ricerca Corrente by the Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Chronic myelomonocytic leukemia (CMML) is a hematological neoplasm characterized by monocytosis, splenomegaly, thrombocytopenia, and anemia. Moreover, it is associated with SRSF2 mutations and, rarely, with CSF3R variants. We present the case of an 84-year-old patient with persistent anemia and monocytosis. Due to the presence of dysmorphic granulocytes, monocyte atypia, and myeloid precursors in the peripheral blood cells, the patient was subjected to a bone marrow examination. The diagnosis was consistent with CMML type 2. The Hemocoagulative test showed an increase in fibrinolysis markers. Next-generation targeted sequencing showed TET2 and SRSF2 mutations, along with an unexpected CSF3R germline missense variant, rarely encountered in CMML. The patient started Azacitidine treatment and achieved normal hemostatic process values. In conclusion, we identified a heterozygous germline mutation that, together with TET2 and SRSF2 variants, was responsible for the hemorrhagic manifestation.<\/jats:p>","DOI":"10.3390\/ijms242216021","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T10:52:47Z","timestamp":1699354367000},"page":"16021","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Germline CSF3R Variant in Chronic Myelomonocytic Leukemia: Linking Genetic Predisposition to Uncommon Hemorrhagic Symptoms"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9299-9189","authenticated-orcid":false,"given":"Maria Teresa","family":"Bochicchio","sequence":"first","affiliation":[{"name":"Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Micucci","sequence":"additional","affiliation":[{"name":"Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Asioli","sequence":"additional","affiliation":[{"name":"Department of Pathology, Morgagni-Pierantoni Hospital, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Ghetti","sequence":"additional","affiliation":[{"name":"Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6954-969X","authenticated-orcid":false,"given":"Giorgia","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0624-5311","authenticated-orcid":false,"given":"Alessandro","family":"Lucchesi","sequence":"additional","affiliation":[{"name":"Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","article-title":"The 2016 Revision to the World Health Organization Classification of Myeloid Neoplasms and Acute Leukemia","volume":"127","author":"Arber","year":"2016","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.3324\/haematol.2019.222059","article-title":"Proposed Diagnostic Criteria for Classical Chronic Myelomonocytic Leukemia (CMML), CMML Variants and Pre-CMML Conditions","volume":"104","author":"Valent","year":"2019","journal-title":"Haematologica"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1182\/blood-2014-03-560227","article-title":"Driver Somatic Mutations Identify Distinct Disease Entities within Myeloid Neoplasms with Myelodysplasia","volume":"124","author":"Malcovati","year":"2014","journal-title":"Blood"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"20834","DOI":"10.18632\/oncotarget.15355","article-title":"Clinical Significance of CSF3R, SRSF2 and SETBP1 Mutations in Chronic Neutrophilic Leukemia and Chronic Myelomonocytic Leukemia","volume":"8","author":"Ouyang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6337","DOI":"10.12998\/wjcc.v8.i24.6337","article-title":"Eighty-Year-Old Man with Rare Chronic Neutrophilic Leukemia Caused by CSF3R T618I Mutation: A Case Report and Review of Literature","volume":"8","author":"Li","year":"2020","journal-title":"World J. 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