The presence and number of additional molecular mutations, notably in SRSF2, ASXL, and/or RUNX1 (S/A/R), have a strong adverse influence on progression (leukemic transformation) to secondary MCL and/or secondary acute myeloid leukemia (AML), response to treatment, and OS.8-10,13-15 To date, the independent prognostic value of most variables and proposed risk scores has been derived from relatively small sets of patients, and they have not been confirmed or validated.14 This evidence concerns the gene RUNX1 and acute myeloid leukemia.