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Principal component analysis revealed two main axes that distinguish paediatric from adult AML, with notable LSPC\u2010Cycle and ProMono\u2010like phenotype enrichment. LSPC\u2010Cycle (&gt;25% cycling stem\u2010like cells) had proliferative and quiescent LSPCs, frequent French\u2010American\u2010British (FAB)\u2010M7 and worst prognosis (overall survival odds ratio vs. GMP\u2010like: 11.33). Morphology was related to the primitive (FAB\u2010M0), GMP\u2010like (M2\/M4) and ProMono\u2010like (M5) groups. Genomic patterns aligned with hierarchy:\n                    <jats:italic>CBFA2T3::GLIS2<\/jats:italic>\n                    ,\n                    <jats:italic>MYB::GATA1<\/jats:italic>\n                    and\n                    <jats:italic>MECOM<\/jats:italic>\n                    high expression in LSPC\u2010Cycle;\n                    <jats:italic>CBFB::MYH11<\/jats:italic>\n                    ,\n                    <jats:italic>NUP98::NSD1<\/jats:italic>\n                    and\n                    <jats:italic>NPM1<\/jats:italic>\n                    in the intermediate; and\n                    <jats:italic>DEK::NUP214<\/jats:italic>\n                    and\n                    <jats:italic>NUP98::KDM5A<\/jats:italic>\n                    were concentrated in the primitive group. bZIP\n                    <jats:italic>CEBPA<\/jats:italic>\n                    and\n                    <jats:italic>FLT3<\/jats:italic>\n                    \u2010ITD mutations clustered in the intermediate and primitive groups. Most of\n                    <jats:italic>RUNX1::RUNX1T1<\/jats:italic>\n                    clustered in the intermediate group, whereas\n                    <jats:italic>KMT2A::MLLT3<\/jats:italic>\n                    hierarchy differed with\n                    <jats:italic>MECOM<\/jats:italic>\n                    expression level. Paediatric AML comprised more primitive cells, rarely with mono\u2010like\/cDC\u2010like dominance. LSPC\u2010Cycle,\n                    <jats:italic>FLT3<\/jats:italic>\n                    \u2010ITD and\n                    <jats:italic>NUP98::KDM5A<\/jats:italic>\n                    were considered independent prognostic factors in multivariate analysis. Findings indicate the prognostic relevance of cellular hierarchy and the importance of integrating hierarchy\u2010specific molecular profiles for improved risk stratification and treatment formulation.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70355","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T13:16:54Z","timestamp":1770124614000},"page":"1252-1262","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identification of cellular hierarchy in paediatric acute myeloid leukaemia: The Japan Children's Cancer Group trial (\n                    <scp>JCCG AML<\/scp>\n                    \u201012)"],"prefix":"10.1111","volume":"208","author":[{"given":"Tomoya","family":"Komori","sequence":"first","affiliation":[{"name":"Department of Pediatrics Yokohama City University Hospital  Yokohama Kanagawa 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