BCR and acute lymphoblastic leukemia: The clinical significance of e1a3 fusion gene remains undermined, we can learn from this rare case that Ph-positive ALL expressing e1a3 BCR-ABL transcript has a poorer prognosis and is more likely to have mutations in the ABL kinase region such as T315I, and third-generation TKI and allo-HSCT or other new treatments should be considered as the initial treatment.