Chronic neutrophilic leukemia natural history, compilications and prognosis

Course of the disease is variable in CNL patients, developing blast crisis is happened in most patients. Moreover, Progression to acute myeloid leukemia may seen in 10-21.2% of patients with CNL. Common complications of CNL include predisposing to hemorrhage, progression of disease, blastic or leukemic conversion and treatment-related toxicity .Prognosis is generally poor, and the 5-year survival rate of patients with CNL is approximately 28%. Some criteria same as treatment resistance, refractory neutrophilia, increasing in red blood cells, platelet transfusion dependency, deterioration of organomegaly and blast crisis indicate disease progression.

• Course of the disease is variable in CNL patients, developing blast crisis is happened in most patients. Moreover, Progression to acute myeloid leukemia may seen in 10-21.2% of patients with CNL.^[1][2][3]

• The common complications of CNL include:^[4][5]
  • Predisposing to hemorrhage (intracranial hemorrhage as the most common cause of death in CNL patients)
  • Progression of disease
  • Blastic or leukemic conversion
  • Treatment-related toxicity

• Prognosis is generally poor, and the 5-year survival rate of patients with CNL is approximately 28%.^[3][6]

• The factors that can predict poor outcomes are:^[1][7][8]
  • White blood cell count > 50,000 cells per microliter
  • ASXL1 mutation
  • Thrombocytopenia
  • Advanced age
  • Dependency to transfusion
  • Peripheral blasts ≥ 1%
  • Marrow blasts ≥ 10%
  • Splenomegaly
• The evidence of disease progression in CNL patients include:^[9]
  • Treatment-resistant
  • Refractory neutrophilia
  • Increasing in red blood cells
  • Platelet transfusion dependency
  • Deterioration of organomegaly
  • Blast crisis

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