Furthermore, T/M-MPAL is characterized phenotypically by the expression of either CD3 and MPO or at least two markers of monocytic differentiation (CD11c, CD14, CD64, lysozyme) [1]. Therefore, to confirm the T lymphoid nature of ETP-ALL lymphoblasts, it is recommended to use cytoplasmic CD3, CD7 and MPO according to the recommendations of “The Italian Association of Pediatric Hematology and Oncology-Berlin Frankfurt Munich” [10]. The gene discussed is LYZ; the disease is mixed phenotype acute leukemia.