A large multicenter, international study looked at 110 cases of MPAL and found 81 recurrently mutated genes to include FLT3 (27%), RUNX1 (13%), CDKN2A or CDKN2B (19%), ETV6 (20%), VPREB1 (13%), WT1 (24%), and KMT2A (23%) [15]. This evidence concerns the gene VPREB1 and mixed phenotype acute leukemia.