To explain the origin of these t-MNs secondary to an initial AML it was proposed that the treatment of the originary AML eradicated the leukemic clones, with the exception of early clones of leukemogenesis responsible for clonal hematopoiesis; these clones acquire new gene mutations such as IDH mutations and emerge as a second leukemia neoplasm related to, but distinct from the originary AML. The gene discussed is IDH1; the disease is leukemia.