Two patients (2/6, 33.3%) were primary refractory: one (AML#2) received intensive chemotherapy (GIMEMA AML1819 trial; PMCID: PMC10429782), “3 + 7” plus gentuzumab ozogamicin), being diagnosed with NPM1-mutated AML and ELN favorable risk (normal cytogenetics), and the other (AML#1) received induction therapy with CPX-381, presenting with hyperleukocytosis (100k/ul), AML with cytogenetic alterations associated with MDS (monosomy 7), and ELN adverse risk. Here, NPM1 is linked to acute myeloid leukemia.