Acquisition of new somatic mutations and/or karyotype evolution at the time of secondary SM-AML was observed in 15/16 (94%) patients: 4 patients revealed acquisition of new somatic mutations (NPM1, n = 2; IDH2, n = 1; JAK2, n = 1) without karyotype evolution, 5 patients with karyotype evolution, and 6 patients with acquisition of new somatic mutations (TP53, n = 2; NPM1, n = 1; RUNX1, n = 1; ASXL1, n = 1; BCOR, n = 1; IDH1/2, n = 1) and karyotype evolution (Table 2, Supplementary Table 3). The gene discussed is NPM1; the disease is acute myeloid leukemia.