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Although she underwent standard chemotherapy, immunotherapy, and hematopoietic stem cell transplantation, the leukemic clone continuously switched on acute myeloid leukemia (AML) or ALL and maintained immunoglobulin\/T\u2010cell receptor rearrangements in addition to showing a high therapy\u2010escaping grade. As other genes are involved in this event, and after considering the selective pressure imposed by the applied treatment, characterizing the cell\u2010of\u2010origin that is capable of proliferating toward both lineages while attempting to design targeted therapies is mandatory.<\/jats:p>","DOI":"10.1002\/pbc.31950","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T09:31:44Z","timestamp":1754040704000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multiple Lineage Switches in a Pediatric Case With a <i>KMT2A::AFF1<\/i>\u2010Positive Acute Lymphoblastic Leukemia: How Cell Plasticity Induces Immunotherapy Failure"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2480-1799","authenticated-orcid":false,"given":"Luca","family":"Lo Nigro","sequence":"first","affiliation":[{"name":"Center of Pediatric Hematology Oncology Azienda Policlinico, G. Rodolico  Catania Italy"},{"name":"Cytofluorimetric\u2010Cytogenetic\u2010Molecular Biology Laboratory, Center of Pediatric Hematology\u2010Oncology Azienda Policlinico, G. Rodolico  Catania Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Arrabito","sequence":"additional","affiliation":[{"name":"Center of Pediatric Hematology Oncology Azienda Policlinico, G. Rodolico  Catania Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuela","family":"Cannata","sequence":"additional","affiliation":[{"name":"Center of Pediatric Hematology Oncology Azienda Policlinico, G. Rodolico  Catania Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"La Rosa","sequence":"additional","affiliation":[{"name":"Cytofluorimetric\u2010Cytogenetic\u2010Molecular Biology Laboratory, Center of Pediatric Hematology\u2010Oncology Azienda Policlinico, G. 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