Targeted NGS on CD34+ cells revealed a higher VAF for the previously detected NRAS Y64D mutation (90.9%), indicating an evolution to homozygosity, along with a newly acquired NRAS mutation (c.35G>A, p.G12D), known as pathogenic in many types of cancers, including myeloid neoplasms (19), displaying a VAF of 43%. Here, NRAS is linked to myeloid neoplasm.