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Its germline and somatic deregulation have both been implicated in the development of B-cell precursor acute lymphoblastic leukemia (BCP-ALL). However, the process how reduced <jats:italic>PAX5<\/jats:italic> transcriptional activity mediates progression to BCP-ALL, is still poorly understood. Here, we characterized the longitudinal effects of PAX5 reduction on healthy, pre-leukemic and BCP-ALL cells at the single-cell level. Cell-surface marker analysis revealed a genotype-driven enrichment of the pre-BII population in healthy <jats:italic>Pax5<\/jats:italic>\n            <jats:sup>\u00b1<\/jats:sup> mice. This population showed downregulated B-cell receptor signaling, while DNA replication\/repair and cell-cycle signaling pathways were upregulated. Moreover, we observed a shift in the kappa\/lambda light chain ratio toward lambda rearranged B-cells. Transplantation experiments further validated a delay of <jats:italic>Pax5<\/jats:italic>\n            <jats:sup>\u00b1<\/jats:sup> pre-BII cells in maturation and transition to IgM-positivity. Additionally, single-cell RNA-Sequencing and bulk ATAC-Sequencing of different stages of BCP-ALL evolution showed that <jats:italic>Pax5<\/jats:italic>\n            <jats:sup>\u00b1<\/jats:sup> pre-leukemic cells lose their B-cell identity and display <jats:italic>Myc<\/jats:italic> activation. Subsequently, BCP-ALLs acquired additional RAG-mediated aberrations and driver mutations in JAK-STAT and RAS-signaling pathways. Together, this study elucidates molecular and functional checkpoints in PAX5-mediated pre-leukemic cell progression exploitable for therapeutic intervention and demonstrates that PAX5 reduction is sufficient to initiate clonal evolution to BCP-ALL through activation of MYC.<\/jats:p>","DOI":"10.1038\/s41375-025-02626-2","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T10:13:41Z","timestamp":1747736021000},"page":"1607-1626","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Trajectories from single-cells to PAX5-driven leukemia reveal PAX5-MYC interplay in vivo"],"prefix":"10.1038","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1193-6002","authenticated-orcid":false,"given":"Franziska","family":"Auer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5812-9526","authenticated-orcid":false,"given":"Mina N. 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