Along with the mutations in SETBP1, other secondary genetic alterations are also observed as clonal events in JMML patients, including mutations in hematopoietic commitment transcription factors (RUNX1, GATA2, RARA, and HOXA11), spliceosome components (ZRSR2), cAMP pathway components (PDE8A), structural protein components and regulators (WASP, DYNC1H1, TNS3, COL22A1, KRT1, and SMC1A), or JAK/STAT pathway components (JAK3 and SH2B3), among others (Table 1) [29,37,64,73,74,81,84,86,87,88,89]. This evidence concerns the gene PDE8A and juvenile myelomonocytic leukemia.