A greater proportion of patients with post-AHD sAML and tAML had adverse ELN risk compared to patients with dnAML (69% and 82% versus 53% respectively, P < 0.001) and a greater proportion were TP53-mutated (36% and 25% versus 12% respectively, P < 0.001). The gene discussed is TP53; the disease is mitochondrial DNA depletion syndrome 4a.