NRAS and acute myeloid leukemia: In addition, mutations in genes involved in signal transduction, including FLT3, NRAS, and PTPN11, as well as mutations in the transcription factors NPM1 and WT1, and in the metabolic enzymes IDH1 and IDH2, tend to be newly acquired during progression to s-AML and are associated with a higher risk of s-AML and shorter survival [25].