Concordant ETV6::RUNX1-positive acute lymphoblastic leukemia in monozygotic twins: a case report and review of the literature.
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Patient A, a 1-year-and-6-month-old male, was admitted due to "fever for 2 days". Patient B, a 1-year-and-9-month-old male, the monozygotic twin brother of Patient A, was admitted due to "fever for 1 day and abnormal blood findings detected 1 h prior to admission". The twin siblings underwent bone marrow examinations and were consecutively diagnosed with acute lymphoblastic leukemia, both testing positive for the ETV6::RUNX1 fusion gene. They received chemotherapy according to the CCLG-ALL-2018 protocol for 2 years, and both achieved complete remission. Since the completion of treatment, they have remained in continuous complete remission for over 2 years of follow-up. This case report provides additional clinical evidence supporting "the in utero origin" and "two-hit" hypotheses in pediatric ALL.