CD4 and acute lymphoblastic leukemia: Unregulated Notch signaling drives normal hematopoietic stem cells to the CD4/CD8 double-positive stage of T-cell development (Pui et al. 1999); in contrast, Notch-mutated ETP-ALL cells, as in our case, arrest at what appears to correspond to an earlier stage of T-cell development during which cells maintain a potential for myeloid fate.