Recurrent secondary driver hits that contribute to clonal expansion and disease evolution include RUNX1 (20%), SETBP1 (12%) and EZH2 (8%), which contribute to the MD-CMML phenotype, and ASXL1, seen in both MD an MP-CMML, being more prevalent in the latter [4,31,32,50,54]. The gene discussed is EZH2; the disease is Menkes disease.