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A molecular explanation for this rare phenomenon is missing. However, the clonal haematopoiesis mostly present in these patients may work as a seeding soil for a second neoplastic disease. Molecular results from this case study reporting a secondary Acute Lymphoblastic Leukemia presenting after Essential Thrombocythemia support this hypothesis. In this contest secondary Acute Lymphoblastic Leukemia should not be considered as real blast crisis, but rather as a second cancer determined by a different clonal route. Given the unique features of this case, a review of the published cases of MPN transforming to Acute Lymphoblastic Leukemia available in literature is provided in the article.<\/jats:p>","DOI":"10.1007\/s00277-025-06404-z","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T21:30:55Z","timestamp":1747863055000},"page":"2897-2904","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Molecular analysis of T-cell Acute Lymphoblastic Leukemia arising after Essential Thrombocythemia foreshadows a distinct clonal route for lymphoid blast crisis in Philadelphia-negative chronic myeloproliferative neoplasm: a case report with literary review"],"prefix":"10.1007","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4365-9406","authenticated-orcid":false,"given":"Francesco","family":"Grimaldi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1922-6048","authenticated-orcid":false,"given":"Mara","family":"Memoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Avilia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Russo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Scalia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Visconti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santa","family":"Errichiello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7021-0367","authenticated-orcid":false,"given":"Barbara","family":"Izzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Pane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"issue":"22","key":"6404_CR1","doi-asserted-by":"publisher","first-page":"2168","DOI":"10.1056\/NEJMra1406186","volume":"376","author":"JL Spivak","year":"2017","unstructured":"Spivak JL (2017) Myeloproliferative neoplasms. 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