Few studies have documented the presence of complex karyotypes in conjunction with atypical BCR::ABL1 transcripts.[16] Ray et al[21] were the first to report a case of MPAL where monosomy 7 and the BCR::ABL1 gene fusion coexisted, highlighting the translocation t(9;22)(q34;q11.2) as an indicator of poor prognosis. The gene discussed is ABL1; the disease is mixed phenotype acute leukemia.