[27, 36, 37] In our study, there were four cases of clonal progression; all were older than 50 years, three cases progressed to MDS with normal chromosomal karyotype and no detectable somatic mutations at the time of the sequence analysis before diagnosis, and one case progressed to AML with three somatic mutations, ASXL1, SETBP1 and RUNX1, respectively. The gene discussed is SETBP1; the disease is acute myeloid leukemia.