{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:06:51Z","timestamp":1784696811031,"version":"3.55.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a high-risk subtype of T-cell acute lymphoblastic leukemia (T-ALL). Aberrant CD19 expression in ETP\u2212ALL may lead to misdiagnosis of mixed-phenotype acute leukemia. Notably,\n                      <jats:italic>nucleophosmin 1 (NPM1)<\/jats:italic>\n                      mutations, an established molecular hallmark of acute myeloid leukemia (AML), are extremely rare in T\u2212ALL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>\n                      We present the case of a 29\u2212year\u2212old male with progressive right retroauricular and cervical lymphadenopathies complicated by severe febrile neutropenia and polymicrobial sepsis. Peripheral blood testing revealed 80% blasts. Bone marrow flow cytometry demonstrated blasts strongly positive for cytoplasmic CD3 and CD7, with aberrant CD19 expression and co\u2212expression of CD34, CD33, and dim cytoplasmic CD79a. The blasts showed dim CD5 expression but were negative for CD1a, CD8, CD10, CD22, and myeloperoxidase, consistent with an ETP-ALL immunophenotype. Next\u2212generation sequencing identified\n                      <jats:italic>an NPM1<\/jats:italic>\n                      frameshift mutation (p.W288Cfs*12, Type A) and an internal tandem duplication of the\n                      <jats:italic>Fms\u2212like tyrosine kinase 3<\/jats:italic>\n                      gene\n                      <jats:italic>(FLT3<\/jats:italic>\n                      \u2212ITD\n                      <jats:italic>)<\/jats:italic>\n                      , both classic AML\u2212associated mutations. After management of severe sepsis, the patient received three cycles of VHAG (venetoclax, homoharringtonine, cytarabine, and granulocyte colony-stimulating factor)\u2212based chemotherapy followed by haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). He remained in sustained complete remission at the 7-month follow\u2212up after allo-HSCT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      To our knowledge, this case represents the first reported ETP-ALL with an\n                      <jats:italic>NPM1<\/jats:italic>\n                      frameshift mutation (p.W288Cfs*12, Type A), which also exhibited aberrant CD19 expression, highlighting the diagnostic challenges posed by unusual immunophenotypic and genomic profiles.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1890324","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:44:20Z","timestamp":1784695460000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Early T-cell precursor acute lymphoblastic leukemia with aberrant CD19 expression and an NPM1 mutation"],"prefix":"10.3389","volume":"16","author":[{"given":"Yan","family":"Lu","sequence":"first","affiliation":[{"name":"Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University","place":["Dongyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiran","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Hangzhou City University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaohong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University","place":["Dongyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gongqiang","family":"Wu","sequence":"additional","affiliation":[{"name":"The Department of Hematology, Affiliated Dongyang Hospital of Wenzhou Medical 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