Patients harboring the Y640F mutation have an overall higher response rate to methotrexate compared to wildtype, especially those with symptomatic anemia...Patients harboring the D661Y mutation have an overall higher response rate to cyclophosphamide and a lower response rate to methotrexate...Methotrexate should be the first line treatment for patients harboring Y640F mutation, especially those with symptomatic anemia. Cyclophosphamide should be the first-line treatment for patients harboring the D661Y mutation, especially those with neutropenia.