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It is one of three new endgame pinnacle bosses in Path of Exile alongside Fear and Dread. Defeating all three earns the Originator Voidstone which enables Exceptional Support Gems to drop from specific Atlas bosses. Neglect is also associated with the Frostmage Support gem which is among the most sought after Exceptional Supports in the league.

It is an Exceptional Support Gem tied to the Incarnation of Neglect that enables mana stacking builds to scale cold damage to an extraordinary degree. It is one of the more build-defining gems introduced in Mirage 3.28 and a reason many players farm this encounter beyond the initial Voidstone unlock.

Yes. The Originator Voidstone requires defeating Fear, Neglect and Dread together. Neglect alone does not unlock it but it is a required step in the chain.